Author: Dr. Liam Little

Candida is a genus of yeast that usually lives on the skin and in the body without causing any problems but can lead to an infection (candidiasis) due to an overgrowth or imbalance. A number of therapeutic approaches have been developed for the management of Candida and candidiasis. In this blog, we will explore the most prominent traditional Candida therapies, along with other emerging strategies in the management of Candida growth.

Tackling Candida with Antifungal Agents

Antifungal agents are the conventional approach to Candida management and are still widely used to treat infections today. Traditional classes of antifungals (azoles, polyenes, and pyrimidines) have been used for many years but newer classes of drugs, such as echinocandins, have also been developed.

Azoles cause fungal cell death by disturbing both the fungal cell membrane and fungal wall integrity. Azoles are further categorized into two subclasses – imidazoles and triazoles. Imidazoles were the first of these to be used; unfortunately, they showed some toxicity toward human cells and were replaced by triazoles, which show fewer side effects and better activity toward fungi.

Polyenes also target the fungal cell membrane, leading to the production of reactive oxygen species (ROS), inhibition of membrane transporters, and fungal cell death. Nystatin and amphotericin B are the most commonly used polyenes against Candida, particularly in the treatment of oral candidiasis where they can be administered as a rinse and spit solution.

Flucytosine (5-FC) is the primary pyrimidine used against Candida infections and produces antifungal effects that lead to the interference of DNA, RNA, and translation. 5-FC is often used in combination with amphotericin B, as the use of the pyrimidine alone induces greater side effects, such as hepatic impairment, interference with bone marrow function, and rapid resistance in Candida species.

Echinocandins show a fungicidal mechanism of action similar to that of penicillin on bacterial cell walls, blocking the synthesis of β-glucan in fungi. This mechanism of action means that echinocandins have fewer side effects, as human cells do not have cell walls. Echinocandins have also shown fungicidal effects against all Candida species and may be used in cases of azole resistance.

Allylamines (such as terbinafine and naftifine) and thiocarbamates are two other classes of antifungals that share the same mechanism of action. They inhibit the enzyme squalene-epoxidase, which leads to membrane rupture, accumulation of squalene, and fungal cell death.

Prolonged Antifungal Use: The Threat of Antifungal Resistance

Even with the introduction of echinocandins, treatment against fungal infections has relied heavily on a small number of antifungal drugs for many years. Despite the well-established antifungal effect of these drugs, treatment failure is now a commonly reported clinical outcome. This is because fungi are highly responsive to chemical attack, leading to antifungal resistance in multiple strains, including Candida albicans and Candida auris.

In the past, fungi have been widely neglected as a threat to human health but antifungal resistance is now a serious public health issue that threatens to affect billions of people worldwide. Antifungal resistance is a complex interplay of host immune response, drug properties, and fungal characteristics, highlighting the need for alternative or complementary strategies for the management of fungal infections such as Candida. It is also important to note that natural antifungals are less likely to cause resistance than pharmaceutical antifungals.

The Influence of Diet on Candida

Of the many risk factors related to Candida infection, diet represents an area that an individual can control in order to minimize their risk of Candida overgrowth. Specifically, diets high in refined carbohydrates and sugar, along with high alcohol consumption increase the risk of Candida infection. A “Candida diet” is one that excludes sugar, gluten, alcohol, some dairy products, and additives while encouraging low-sugar fruits, non-starchy vegetables, and gluten-free foods.

Although the Candida diet has not been specifically supported by scientific studies, it is designed to be anti-inflammatory and reduce chronic inflammation. Inflammation has been associated with many different diseases including Type 2 diabetes, cancer, and inflammatory bowel syndrome. Colonization of Candida in the gastrointestinal tract has also been shown to increase inflammation. Following a Candida diet may therefore be a beneficial strategy in the management of Candida overgrowth.

Dietary supplements (such as bacterial probiotics) have emerged as an alternative, or complementary, therapy for the management of Candida overgrowth and infection. Lactobacillus and Bifidobacterium are among the most researched probiotic strains and supplements may help alleviate inflammation, destroy harmful microorganisms, and tackle Candida and infection symptoms. Combining antifungals with probiotics is also completely safe and can lead to beneficial synergistic effects.

Beyond Diet: Alternative and Complementary Candida Strategies

Aside from diet, there are several other factors that increase the risk of Candida infections. Some of these are difficult to control, such as the use of antibiotics or hormonal imbalances. For others, strategies can be implemented, with the aim of reducing the risk of Candida infection to improve overall health and wellbeing.

It is well understood that stress can have a significant negative impact on physical health. In relation to Candida, stress can weaken the immune system and increase the chance of infection. For example, stress, anxiety, and depression have been associated with higher levels of vulvovaginal candidiasis.

Another factor that has been linked to a reduced immune system is a lack of sleep. This means that prolonged sleep deprivation leaves individuals more susceptible to opportunistic yeasts (like Candida), and the development of Candida infection. Beyond this, it has also been suggested that sleep and immunity have a bidirectional relationship. This means that a lack of sleep can increase the risk of infection, and the immune response to that infection can also alter sleep patterns.

Combining Strategies to Reduce Candida Risk

A poor diet, increased stress, and sleep deprivation all increase the risk of Candida overgrowth but all also show a lack of overall good health and wellbeing. All of these factors result in an unbalanced gut microbiome, allowing Candida to overgrow and infections to develop.

An optimal strategy for the management of Candida would therefore be one that aims to address diet, stress, and sleep, all at the same time. By addressing these in combination, the balance of the gut microbiome can be restored, overall health and wellbeing can improve, and the risk of Candida overgrowth and infection can be decreased. CanXida offers solutions for the removal of Candida, probiotic supplements to restore healthy gut function, and multivitamin formulations to support gut health.