Nutrition therapy for recurrent candida overgrowth

By Kellie Blake, RDN, LD, IFNCP

Recurrent vulvovaginal candidiasis (RVVC) is defined as four vaginal yeast infections in a one year period or three infections not associated with antibiotic use.  The U.S .Centers for Disease Control and Prevention estimates 1.4 million outpatient visits each year are due to vaginal candidiasis and up to 75 percent of all women experience a yeast infection at some point during their lifetime.  

Candida is a fungus naturally present on the skin and in the gastrointestinal tract.  Normally, the immune system keeps candida in healthy balance with the other gut microbiota, but if the immune system is compromised from unmanaged stress, chronic disease, increased intestinal permeability, medication use, or poor nutrition, the balance shifts and candida can take hold leading to vaginal and oral/nasal symptoms.  Candida infections can also become more serious by traveling in the bloodstream and invading systemic tissues. Candida is extremely difficult to eradicate due to the formation of biofilms that protect this potentially pathogenic fungi from harm. Oral and topical antifungal medications can be effective treatments for isolated vaginal candida infections, but for the five to eight percent of women of reproductive age who develop RVVC, a more comprehensive approach is required. 

Eradicating candida overgrowth requires an accurate diagnosis and determination of root causes. Candida screening can be a valuable tool for those with overgrowth symptoms, keeping in mind clients that have been exposed to numerous antibiotics or steroids or who have taken oral birth control will be at increased risk. Ask patients about the frequency and type of vaginal symptoms and try to obtain a fungal culture, comprehensive stool analysis, or urine organic acids panel to correctly identify RVVC cases.  

While nutrition therapy for RVVC is not well established, it is nonetheless critical for long-term recovery.  Tailoring the nutrition plan based on root causes can be a good place to start.  Since one proposed root cause of RVVC is dysbiosis, targeting gut health with the 5R gut protocol, a means of helping to restore the natural balance of the gastrointestinal tract, can dramatically improve symptoms and create an environment for symptom reversal. Removing stressors, replacing digestive secretions, reinoculating with good bacteria, repairing the gut lining, and rebalancing the lifestyle will create an environment that is inhospitable to candida.

When candida overgrowth is suspected or confirmed, a functional medicine candida control elimination protocol can be implemented as part of the 5R plan. It is generally accepted that candida thrive in a carbohydrate-rich environment, so restricting foods high in starch and sugar is vital. Foods high in fungal content and those created by fermentation must also be avoided.  For a period of at least two weeks, RVVC clients should eliminate:

• All grains and flours
• All starchy vegetables (beets, corn, potatoes, peas, yams, and winter squash)
• All fruit
• Peanuts, pistachios, and peanut butter
• Processed meats
• Mushrooms
• Dairy, except plain unsweetened yogurt with live cultures
• Unhealthy fats 
• Vinegars and preserved foods
• Alcohol
• Artificially and sugar-sweetened beverages 
• Caffeinated beverages

Most clients will experience much symptom improvement during the two to four week elimination period. When food reintroduction begins I encourage clients to proceed slowly, introduce foods in their unprocessed forms, and to keep a food and symptom journal to determine specific foods that may trigger symptom recurrence. Even after successful treatment, women can remain colonized, so keeping candida in check can be difficult. For long-term recovery, I recommend a lower-carbohydrate meal plan that restricts simple sugars, alcohol, and trigger foods. Adding coconut oil daily has been shown to reduce gastrointestinal colonization by candida and the probiotic L. acidophilus can help to normalize the gut flora to decrease the likelihood of Candida overgrowth. Other lifestyle modalities to address stress, sleep, and exercise can work in conjunction with the nutrition-related changes to reverse symptoms.   

Case Study

CC is a 40-year-old female with complaints of vaginal itching and burning, headache, fatigue, brain fog, and acne. She reported significant pre-menstrual syndrome symptoms despite having her uterus and cervix removed.  She indicated she “felt terrible” for nine days every month, had significant vaginal and gastrointestinal symptoms and broke out into hives, which had since subsided. Initially, CC self-medicated with over-the-counter antifungal medications and a peroxide and water solution. Her gynecologist then ordered numerous rounds of diflucan with no significant relief and finally started CC on diflucan twice daily for several months. She reported staying on the oral medication as prescribed but eventually discontinued use due to GI pain. CC sought nutrition therapy as a last resort. 

CC is a very busy mom of four and nutrition history revealed she was eating out frequently, 50-75 percent of meals each week, in between her kids activities. CC reported eating sweets, processed foods and drinking soda daily. CC wanted to learn how to incorporate healthy eating into her busy lifestyle to improve her symptoms and for the health of her family. CC did not have testing to confirm RVVC, but her symptoms were consistent with this chronic condition.  

The initial treatment plan included a full elimination diet for four weeks, meditation daily, and CC was encouraged to meal prep and plan healthy snacks for her busy schedule. A comprehensive stool analysis and urine organic acids panel were recommended, but not completed. It was also recommended she take a multivitamin and probiotic; however she reported not being able to remember to take them so she focused on eating wholesome foods.

After one month on the program, she reported much improvement in her symptoms. She started the reintroduction of foods and quickly realized caffeine, gluten, and dairy caused vaginal symptoms to flare.  She again avoided her specific triggers and had dramatic reduction in symptoms. CC was educated to continue to avoid trigger foods and was placed on a lower carbohydrate plan with very limited simple sugar. She remained symptom free and after five months on the maintenance plan, she reported drinking a sugar-sweetened beverage and eating sushi. Many of her initial symptoms returned with significant vaginal symptoms exacerbation.

I provided support and encouraged her to again focus on avoiding the trigger foods and other lifestyle measures.  After 11 months, CC reported all of her symptoms were gone and she realized how several little issues could add up to a very big deal. As an added bonus, she reported weighing in back at her pre-baby weight. CC also reported improvements in her mood and stated her family has a much happier wife and mom.  

All chronic conditions like RVVC require a personalized approach to nutrition therapy. Applying the principles to improve overall gut health will reverse many RVVC cases. In addition to the gut protocol, a vitamin B complex has been shown to enhance the effectiveness of traditional RVVC treatment. If significant improvement is not realized after addressing gut health, a reconsideration of other root causes is required.

References

Gunsalus, K., Tornberg-Belanger, S., Matthan, N., Lichtenstein, A., and Kumamoto, C. (2015) Manipulation of Host Diet To Reduce Gastrointestinal Colonization by the Opportunistic Pathogen Candida albican. Msphere. Retrieved from: https://msphere.asm.org/content/1/1/e00020-15 

Murina, F., Graziottin, A., Vicariotto, F., and DeSeta, F. (2014) Can Lactobacillus fermentum LF10 and Lactobacillus acidophilus LA02 in a Slow-release Vaginal Product be Useful for Prevention of Recurrent Vulvovaginal Candidiasis?:  A Clinical Study. Journal of Clinical GastroenterologyRetrieved from: https://www.ncbi.nlm.nih.gov/pubmed/25291115 

Nyirjesy, P. (2001) Chronic Vulvovaginal Candidiasis. American Family Physician. Retrieved from: https://www.aafp.org/afp/2001/0215/p697.pdf

Olmstead, S. (2016) Biofilms Part 1:  The Mycobiome, Candida, and Gastrointestinal Health. ProThera, Inc. Practitioner Newsletter.

Sun, M-G., Huang, Y., Xu, Y-H., Cao, Y-X., (2017) Efficacy of vitamin B complex as an adjuvant therapy for the treatment of complicated vulvovaginal candidiasis:  An in vivo and in vitro study. Biomedicine & Pharmacotherapy. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/28157653 

U.S. Centers for Disease Control and Prevention. (2019) Vaginal Candidiasis. Retrieved from: https://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html

Wong, M. (2016) Possible Treatment Options for Recurrent Yeast Vaginal Yeast Infections. Pharmacy & Pharmacology International Journal. Retrieved from: https://medcraveonline.com/PPIJ/PPIJ-03-00056