Old paradigms die hard and new ideas are generally faced with opposition, obstacles and even ridicule. As humans we are not very open to change – a new idea or theory always faces opposition. Many scientists in the past have gone through criticism, ridicule and even incarceration.
In 1611, Galileo was subjected to inquisition in addition to criticism from his peers for his support of Copernicus’ idea that Earth revolves around Sun and not the other way around as was the belief at that time. In 1840s, Ignaz Semmelweis was ostracized for insisting that the reason for high death rates in hospital maternity wards were because the doctors refused to wash their hands after studying cadavers in hospital morgues and went on to deliver babies with unwashed hands. Later, Louis Pasteur and his germ-theory (which proposed that diseases are caused by microorganisms) were ridiculed until Pasteur and hundreds of others proved it with advancement of new techniques in science. Gregor Mendel was only recognized as father of modern genetics almost a century after his death.
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These are not the tales of times gone by – even in these modern times there are several scientists and their ideas that have been ridiculed for a long time before they were proved to be right. Barbara McClintock, Stanley Prusiner, Dan Shechtman are few of the more recent ridiculed scientists whose ideas that were initially considered crazy finally got them a Nobel Prize after a long time.
While these seem like sad stories, criticism is also good in a way – criticism is the fire that can test gold. Pioneers of a field or an idea are the individuals who are the first to explore it. Pioneering ideas survive and pass the test of criticism and go on to become mainstream ideas. On the other hand, scientists and critics both are also humans and not every ideas/theory is “gold” and not every “fire” is good enough to test the gold. Despite this fact, new ideas of any kind should be listened to and debated upon without the background of distrust and prejudice.
Science by itself is not static – new ideas are tested rigorously according to what are believed to be the best testing tools of that time. These tools also change and may be replaced by better ones – and should also be constantly challenged and tested. Sometimes the knowledge and tools of the time are not advanced enough to match the idea of a scientist. Scientists who are criticizing an idea/theory are required to be constantly aware of this – but being humans, they also forget this sometimes.
Pioneers of candida overgrowth
So who are the true medical pioneers of candida? Dr. Orian Truss and Dr. William Crook were the first true pioneers in the discovery of the true extent of candida infections in the population.
Dr. C. Orian Truss graduated from Birmingham Southern College and Cornell University Medical College. He was Chief of Cardiology and Assistant Chief of Medicine at the US Air Force Hospital at Maxwell Field, Alabama. Prior to starting full-time private practice, he was an Instructor in Medicine at Cornell Medical College and University of Alabama Medical College. He was the first to suggest a possible link between many illnesses and the yeast Candida albicans. Starting from 1978, Dr. Truss wrote his ideas in a series of articles and a book in 1983 entitled “The Missing Diagnosis” and made the suggestion that since the 1950s, the widespread use of antibiotics, combined with the universal use of the oral contraceptive pill and immune suppressing drugs like steroids (hydrocortisone, prednisone, cortisol and asthma preventative steroidal inhalers) coupled with a high carbohydrate type diet (such as bread, alcohol, processed and take-out foods) has caused a dramatic increase in yeast like overgrowths in the human population.
I can remember reading a book written by Dr. William Crook called “The Yeast Connection” in 1983, when my father bought a copy to try and sort his own digestive problems out. Dr. Crook was a medical doctor educated and trained at University of Virginia, The Pennsylvania Hospital, Vanderbilt and Johns Hopkins. He was a Fellow of the American Academy of Pediatrics, the American College of Asthma, Allergy and Immunology and the American Medical Association (AMA). He lived and practiced medicine in Jackson, Tennessee for almost 40 years. In 1979, Dr. Crook learned from Dr. Orian Truss about the relationship of the common yeast called Candida albicans with many illnesses. Being a good listener of his patients’ complaints and having an open mind to new ideas he got interested in chronic health complaints of his patients which seemed to be connected to yeast overgrowth.
To many involved in natural medicine, Dr. Crook was a mentor and a true role model. He was a passionate man who worked tirelessly to improve the public health, primarily by helping publicise the importance of food allergy and of candida yeast infection as causes of illness. As a pediatrician, Dr. Crook became interested in the idea that hidden food allergies were a triggering factor for conditions such as hyperactivity, learning disabilities, fatigue, bedwetting, migraine, colic and other common pediatric problems. After helping thousands of children overcome chronic conditions by means of an elimination diet, Dr. Crook then began to spread the word by writing books and articles on the subject. Many medical and natural medicine practitioners used his book “Tracking Down Hidden Food Allergies” as a blueprint for identifying food allergies in both children and adults.
Dr. William Crook is best known for his role in increasing public awareness of candida albicans yeast infections as a cause of chronic physical and emotional problems. Although Orion Truss, MD, is credited with alerting the medical profession to the yeast-illness connection, it was Dr. Crook’s landmark bestselling book “The Yeast Connection” that gave recognition to a condition which is as big today as it has ever been. Dr. Crook, passed away in October 2002, at the age of 85.
Intestinal candida overgrowth
The idea that candida can overgrow in the intestines, which came into being more than 35 years ago, is still considered controversial and you will find many clinicians and scientists arguing against the concept. However, the idea is not totally brushed under the carpet and the scientific evidence is being constantly monitored – in 2004, Robert Koch Institute from Germany carried out an objective review of the scientific studies in the field. In 2009, Schulz and Sonnenborn from Germany reviewed the data once again. Both these did not find conclusive evidence for the existence of intestinal candida colonization in people with normal immune system. The article by Schulz and Sonnenborn however includes the following key messages:
- Candida in principle can be called a facultatively pathogenic yeast – meaning that it can cause disease under some circumstances but is not always disease causing.
- A large number (102 to 104 candida/gram stools) are found normally in more than 50% of adult population – so such numbers cannot indicate intestinal candida overgrowth.
- Depending on the stability of the mucosa, immune system and intestinal microflora, candida colonization may lead to:
- Superficial candida infections (of skin or mucosa)
- Invasive candida infection that is restricted to a particular area
- Invasive candida infection of the whole system
- Indications most commonly linked to candida colonization are irritable bowel syndrome (IBS) and some allergic reactions. There is no evidence of candida allergy syndrome in terms of epidemiology or treatment
- Modulation of intestinal microflora with probiotics can suppress candida colonization
It can be seen from these points that candida colonization is now considered possible. IBS and allergic reactions are being attributed to candida colonization and that candida colonization can be suppressed by probiotic use is accepted.
A few issues have been dogging the idea of candida overgrowth and some of these were also responsible for the American Academy of Allergy, Asthma and Immunology (AAAAI) to consider the work of Truss and Crook as experimental back in 1986. These issues are:
- How to find out that someone actually has increased growth of candida in their intestines when 50% of the population normally has really large number of candida in their guts?
- The issues proposed to be suffered by people with candida overgrowth could apply to almost all sick patients at some point of time as these are universal symptoms.
- As pharmaceutical antifungals were prescribed by Truss and Crook, there is a fear of development of antifungal resistant fungi.
- Additionally, there is also a fear of side-effects of antifungals
- AAAAI considered lack of published proof as lack of evidence
Points 3 and 4 that relate to the possible indiscriminate use of antifungals are valid points – pharmaceutical antifungals have these inherent risks associated with them and therefore must be used with caution if used at all. I do not recommend the use of pharmaceutical antifungals and instead suggest the use of broad-spectrum natural antifungals that do not have these side-effects.
Point 1 refers to lack of technology that could discriminate fungal overgrowth from normal fungal microflora. As you will read later in this article, new, modern methodologies are being applied now and have been successful in such a discrimination, for example, in patients with Crohn’s disease.
Point 2 – yes, the symptoms are generally universal. However, as Dr. Crook put forward in the diagnostic criteria, a lot many of these symptoms should occur at the same time for it to be considered yeast overgrowth issue.
As to point 5 – a lack of experimental evidence at a time when the idea had only come out is but natural! Experimental evidence takes time – scientists need to take these ideas and perform experiments. Biological experiments also take time as a good experiment needs to be designed well, needs to weigh all the possibilities that can occur with differences in individual biology and the experiments by themselves need time to conduct, repeat, and analyse.
You may have come across criticism of Dr. Crook for refusing to perform controlled experiments and arguing that he is a clinician, not a researcher. Well, performing controlled experiments is a skill which is learned by researchers and not clinicians. It is as dangerous to ask a clinician to perform an experiment as asking a lawyer to perform a surgery. It is important that people who have been trained in these skills carry out the work. So there was nothing wrong – it was, in fact, very honest and ethical of Dr. Crook to refuse to perform the experiments and he accepted that he did not have the skills required for proper research work.
Of course, as with anything, there are people who want to make a quick buck off an idea. These are the people who promise a quick cure to those who have been suffering for years without any treatment helping them. The swindlers have no knowledge or experience and base their products/treatment plans on half-baked ideas that they have picked off the books, newspapers, or the internet. The lure of a quick cure has led to many people being swindled (of course they find no relief from such cures) and consequently gave a bad reputation to the idea of candida-overgrowth. In absence of solid scientific proof of the concept, this aids the skeptics in their disbelief of the concept.
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Recent status on candida overgrowth research
There is a continued small but growing body of scientific evidence coming from researchers now concerning this condition. As better tools become available, the currently available evidence will serve a base on which new data can be obtained. There are many candida overgrowth related studies being carried out in cells and in mice and in humans. Let us look at a few of the more recent human studies that point towards the existence of candida overgrowth.
Patients with medically unexplained symptoms have elevated antibodies to candida: A 2007 research by Lewith and colleagues from the UK studied patients with unexplained symptoms who scored high on a modified Fungus Related Disease Questionnaire (FRDQ-7). They found that these patients had significantly high levels of antibodies to candida as compared to a control group that did not score high on the modified FRDQ-7. However, they do mention that having higher antibodies by themselves may not be able to correctly predict who will get such unexplained symptoms and that further studies are needed in this respect.
Candida colonization is seen in patients with gastrointestinal disease: A review article from 2011 by Carol Kumamoto from USA cites many studies that have showed clearly that diseases like Crohn’s disease, ulcerative colitis and gastric ulcers all have candida colonization associated with intestine and stomach mucosa as compared to healthy people.
Issues with proper movement of the gut and overuse of antacids that work through proton pump inhibition are both risk factors for small intestinal bacterial or fungal overgrowth: Research group of SSC Rao from USA have showed in 2013 that when there were issues with the movement of the gut or when people used PPI type antacids a lot, they were 50% more risk for them to get candida colonization and overgrowth in the small intestine.
Fungal dysbiosis is seen in patients with mucosal inflammation in Crohn’s disease: In 2014 a research was published by the Chinese scientists Li and colleagues. They studied patients with active Crohn’s disease. They surgically obtained samples from the inflamed and non-inflamed regions of the patients’ intestines. Using DNA sequence analysis they found that fungi in the inflamed and non-inflamed areas of intestines had different fungi. Candida albicans and Candida tropicalis were found in abundance in inflamed mucosa but were absent in non-inflamed mucosa. Apart from candida, other fungi like gibberella, alternaria and cryptococcus were more in inflamed mucosa compared to non-inflamed mucosa. This is the first report that characterized fungal microbiota in the inflamed regions of intestine as compared to non-inflamed regions.
Thus, slowly, but surely scientific evidence is emerging for the proposition by Dr. Truss and Dr.Crook – a proposition which was based on observation of thousands of patients, listening to them and finding a pattern in their microbiological and biochemical tests. Dr. Truss and Dr. Crook laid the foundation of the concept of candida overgrowth. There are scientists working in the field, building up on their pioneering work, finding and using newer and better tools and methods in their studies and hopefully with these, there will be more scientific evidence forthcoming in the years to come.