“Candida spp., mostly C. albicans, can be isolated in the vaginal tracts of 20 to 30% of healthy asymptomatic nonpregnant women at any single point in time and in up to 70% if followed longitudinally over a 1-year period (25, 27). If the balance between colonization and the host is temporarily disturbed, Candida can cause disease such as vulvovaginal candidiasis (VVC), which is associated with clinical signs of inflammation. Such episodes can happen sporadically or often can be attributed to the presence of a known risk factor, e.g., the disturbance of local microbiologic flora by antibiotic use.” [2010] In other words in a normal natural part of the microbiome. The problem arises when it gets out of balance. With CFS, it can become unclear because  clinical signs of inflammation may occur when candida is in balance!

We know that E.Coli is frequently reported as low or non-existent with CFS patients. Checking pubmed, we find that E.Coli appears to play a significant role in maintaining the balance.

• “Orally administered E. coli strain Nissle 1917 [Mutaflor] reduced Listeria monocyto-genes and Candida albicans in a dose-dependent manner. Treatment with 10(9) cfu of E. coli bacteria led to a reduction of Listeria counts to 7.4% in spleen and 2.4% in liver. A more than 10-fold decrease of viable Candida albicans (residual parasitaemia 6.8%) in the kidneys of the infected animals was also achieved by this E. coli concentration.” [1997]

This begs the question — is blindly killing it, and ignoring the microbiome factors that allow it to get out of balance, the right approach?

Anti-Candida Prescription Drugs

My model of CFS is based on studies of high and low bacteria families. Although this is at a vary coarse level, it is a reasonable level for the information actually available.  Back in 2013, I created a table in a post showing the impact of various antibiotics on these families.

I have taken this table and replaced the antibiotics with anti-candida drugs shown below according to WebMD. I have omitted the intravenous ones.

• “fluconazole (FCZ) possesses minimal inherent bactericidal activity” [1996]
• Nystatin “

As you can see, I really had a hard time to find any information on their impact on bacterial families. The general appearance is that they do not impact the microbiome bacteria families — but that may be solely because no one has studied this.

Probiotics

While there may be beliefs that probiotics help, I want to find actual  studies.  We know that Mutaflor does help from the above study cited at the start of this post. There is only some 200+ articles on pubmed.

“Although the results of different studies are controversial, most have suggested use of probiotics in the prevention or treatment of VVC, and no adverse effects have been reported” [2014]

For many of the studies, there was a mixture or a lot of fuzziness in terms of effectiveness (i.e. a 5% reduction to 10 fold reduction could not be determined). Often their effect is to stop Candida adhering to surfaces, rather than killing off Candida.

• Mutaflor [1997]
• “Prophylactic L. reuteri supplementation is as effective as nystatin, and more effective in reducing the incidence of proven sepsis in addition to its favorable effect on feeding intolerance.” [2015]
• Lactobacillus gasseri OLL2716 [2015]
• Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 exhibit strong antifungal effects against vulvovaginal candidiasis-causing Candida glabrata isolates [2015].
• Lactobacillus plantarum P17630 for preventing Candida vaginitis recurrence: a retrospective comparative study[2014].
• ” A total of 65 patients were randomly assigned to receive oral local antifungal agents alone (gargle 2% sodium bicarbonate solution for 30 s, wait 10 min and then apply 2% nystatin paste) or these agents plus local probiotics (the mixture of Bifidobacterium longum, Lactobacillus bulgaricus and Streptococcus thermophilus) three times per day for 4 weeks… The detection rate of Candida spp. decreased (P = 0.000) in both groups and was significantly lower in the probiotic group than the control group (P = 0.038). ” [2014]
• Probiotic interference of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 with the opportunistic fungal pathogen Candida albicans [2012].

Bottom Line

I am actually unhappy about this post. The reason is that the literature is missing or vague. The main take away is that the following are suggested (with the most powerful on top) to address Candida.

• Mutaflor (E. Coli Nissle 1917)
• L. Reuteri
• L. Gasseri
• L. Rhamnosus
• L.Plantarum

The fact that these probiotics are also in the suggested list for CFS is not surprising. Candida being out of balance is consistent with the microbiome being out of balance in CFS.

• Increased number of Candida albicans in the faecal microflora of chronic fatigue syndromepatients during the acute phase of illness [2007].
• Yeast metabolic products, yeast antigens and yeasts as possible triggers for irritable bowelsyndrome [2005]. Actually the dysfunction may cause both!