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The Candida yeast theory has gained unaccountable popularity. The possible role of yeast in causing chronic, ill-defined illness was popularized by Dr. Crook in the "Yeast Connection" in1984. Other books and magazine articles have repeated the same idea without modification for 2 decades.

This theory tries to explain the whole spectrum of delayed pattern food allergy as "yeast allergy". Somehow, the ingestion of diverse food yeasts and unrelated fungi is associated with the overgrowth of candida albicans in the digestive tract.  The invisible overgrowth of candida  is supposed to cause chronic and systemic symptoms. Therapy is designed to "kill yeast" with over the counter products, prescription drugs and avoidance of sugars and all fungi in the diet. Most candida diets even exclude mushrooms which have only  a remote connection with yeasts (both are fungi). The whole package of candida ideas could win the prize as one of the most popular, prolific and persistent of wrong notions in the "health food" subculture.

Claims that candida overgrowth in the GIT cause ill-defined illnesses are probably not true except in special circumstances. Immune compromised individuals suffer from an overgrowth of  candida and a number of other microorganisms that are usually present as members of the normal flora. Several points are worth considering:

Candida is a symbiotic yeast, which lives in us and on us, as part of our normal collection of microorganisms. In a normal digestive tract, 99% of the candida live in the mouth and colon. The  stomach and small intestine are relatively hostile to candida growth. Candida populations in the colon are constrained by competitive microbes.  The presence of other kinds of yeast or fungi in the diet has little or no effect on the growth of candida in the colon. On a food holiday, the food supply to the Candida and all other colon microorganisms is reduced and the population decreases. The use of an elemental nutrient formula, such as Alpha ENF with  free glucose content is associated with reduction or disappearance of candida in the colon flora. Colon candida are fed by  milk sugar and starches in the diet which reach the colon undigested. Free sugars in food tend to be absorbed by the stomach and upper small intestine before reaching the yeast. The advantage of an ENF is that all nutrients are absorbed before reaching the colon so that the food supply to microorganisms is dramatically reduced; the size of microbial populations shrink. Marshall  [i] suggested: “The normal indigenous flora of the human gastrointestinal tract comprises a remarkably complex yet stable colony of more than 400 separate species, living in a symbiotic relationship with the human host. Stability of that flora is accomplished by multiple mechanisms including gastric acidity, gut motility, bile, products of immune cells in the gut epithelium, and competition between microorganisms for nutrients and intestinal binding sites. The indigenous flora influences multiple aspects of physiologic homeostasis and forms a key component of normal host defenses against infection by exogenous pathogens.”

There are many kinds of fungi in our food supply. Yeast are a highly specialized sub-group and have little in common with molds and  other fungi. Each fungus should be considered on its own merits and demerits. Immune responses to fungi are very specific - not generalized across a broad spectrum on fungi. They may be harmless and some cause illness by varied and diverse mechanisms. Immune responses to different fungal antigens tend to different. Cross reactions may exist, but generally these interactions are unknown.

The overgrowth of candida should always be interpreted as a symptom of an underlying disorder and not the cause of the disorder. Candida yeasts are symbiotic organisms; everyone has lots of them. Yeasts overgrow when conditions are right for them, and can be a nuisance. You cannot get rid of all yeast. You find an ecological balance, with yeast growing at a controlled rate, below the symptom-producing level.

Candida overgrowth is a common cause of vaginitis in women. Men may be troubled by yeast overgrowth on their penis or on the skin around the anus and groin (jock itch). Vaginitis is often provoked or aggravated by sexual intercourse. Many woman suffer prolonged and mysterious vaginal irritation and pelvic pain. Infection is always assumed, and repeated treatment for candida and other organisms often fails. Seldom is the diagnosis of vaginal allergy considered. The vagina often reacts to circulating food allergens with increased mucus production and secondary candida overgrowth. Milk allergy, for example, commonly triggers vaginitis in both children and adults.  Prostaglandins in male semen, and allergic responses to semen and/or sperm may be important contributors to vaginitis in sexually active women.. Wilkins, from Cornell, reported that Candida overgrew in the vaginas of women whose immune response was suppressed by prostaglandin E2. Ibuprofen, a prostaglandin inhibitor, improved the anti-Candida response. Prostaglandins were originally discovered in, and named for, secretions of the male prostate gland. Male semen prostaglandins may, in some couples, inhibit the woman's local immune defense. Sometimes, semen proteins or sperm excite female antibody production and trigger allergic, inflammatory responses.  Vaginal candida overgrowth, as everywhere else, is a symptom of another pathological process, and not a cause of it.

Babies often have Candida overgrowth on the diaper area of their skin, producing the most aggressive from of "diaper rash". This is often seen in food allergic infants - cows milk allergy is the most common cause. Oral growth of Candida is known as "thrush" and is also common in babies. Infants with inborn errors of amino acid metabolism also display prominent thrush.

Candida is irritating and is perceived as whitish surface material associated with local inflammation and itching or burning. A typical sickly-sweet odor is obvious. Vaginal candida overgrows in response to local changes in microbial flora and immune defense induced by oral contraceptive and antibiotic use. It is common in diabetics with elevated sugar in their secretions, since yeast, like Candida, thrive on sugar. Diabetics  with elevated body sugar concentrations do suffer candida overgrowth on the skin, especially  in the groin and axilla.

Antibiotic use damages the ecology of microorganisms in the bowel and on body surfaces, permitting the overgrowth of Candida, and undesirable bacteria. It is reasonable to take oral Nystatin in association with broad-spectrum antibiotics. Tetracycline, an antibiotic which often promotes Candida growth, was once marketed in a capsule which contained Nystatin. Avoidance of antibiotic usage is an even better strategy, especially when antibiotics are often used to treat conditions for which they offer no benefit ( allergy, colds and other viral infections).

Opportunistic growth of candida occurs in people with defective immunity, and can be life-threatening. Metabolites of candida, in increased concentrations, can be toxic, and whole body effects from intestinal overgrowth should be expected.

You cannot be tested for candida allergy. Everyone should be sensitive to candida antigens. The skin test with candida antigen is used as a test of immune-competence. A positive response is usually delayed - the skin reaction is read at 48 hours after injection. If you do not react to candida antigen, something is wrong with your immune response. Immediate reactions (within 30 minutes) to candida antigen injection are difficult to interpret - it does not necessarily mean that "candida allergy" is responsible for your symptoms.

The "yeast connection" theory ignores the many types of adverse reactions to food. Many people with food allergy believe that they have candida and have a hard time adjusting their thinking to accept a more comprehensive solution to their illness. The symptoms attributed to candida are typical of the wide spectrum of adverse reactions to food, and should not be interpreted as having a single cause. People who accept the "yeast connection" are encouraged by product advertisements to buy easy solutions to chronic health problems, which really require responsible, dedicated, and persistent efforts to resolve.

They are encouraged to use prescription antibiotics such as Nystatin and Nizoral, without appreciating the risk of side effects and toxicity. Both antibiotics are potentially toxic. Nystatin is relatively safe only if it is not absorbed from the intestine. The risk of significant absorption increases as the dose of Nystatin is increased and prolonged. Nizoral is routinely absorbed, and has been implicated in hepatitis . The recommended use of Nizoral is limited by this potential toxicity to serious fungal infections not resolved by other means.

Other products are sold and advertised nationally as candida cures. All of these products, including acidophilus, garlic, caprylic acid, herbs, animal gland derivatives, and vitamins, are not likely to influence candida growth and do not contribute to the proper treatment of food allergy.