CLINIC: CASE STUDIES
Fungal infections and antibiotics
SR was a 47 year old journalist living in Scotland and working from home. She reported fungal infections for the last 14 years after the birth of her first child, prior to which she reported the use of antibiotics for childhood ear infections. She developed asthma when she moved to London when she was 22. She used antibiotics again for a sinus infection 2 years previously, and had polyps removed from her nose. She reported constant diarrhoea for the previous year. She occasionally used Salbutamol for asthma when she got coughs or colds.
SR felt sluggish after eating sugar and 3-4 months ago moved from eating chocolate and sweets to fruits, seeds and nuts, on which she was snacking throughout the day. She ate fish and chicken 2-3 times a week but but did not eat red meat as she doesn’t like the texture. Alcohol, and specifically white wine brought on sneezing fits.
SR was concerned as she had ‘seen everybody there was stop see’ about the fungal infection on her toes and had not had any satisfactory treatment. Now the infection had spread to her fingers and she was worried about it spreading further.
- Fungal fingernail and 2 toenails – anti-fungal solution from podiatrist not working
- Allergies, constantly wheezing, stuffy nose
- Diarrhoea 2 x day, 3 x week
- Pain in stomach after fatty food
- Low energy levels but can do exercise in the morning
- Candida infection
- Imbalance between the 2 arms of the immune system, Th1 and Th2, predisposing to Candida overgrowth
- Dysbiosis – an imbalance between beneficial and pathogenic organisms in the gut
- Low stomach acid
- Low bile production by the liver
- High carbohydrate diet
INITIAL HEALTH OPTIMISATION PLAN
Plan rationale: SR was aware that a high carbohydrate diet can promote fungal growth, and she thought that by switching from obviously high sugar foods such as biscuits and cakes to healthier foods such as fruits and oat bars, she would reduce her sugar intake. In fact these ‘healthy’ foods still contain high amounts of sugar if eaten in high quantities. A high sugar diet can destabilise regulation of blood sugar, and this can lead to energy highs and lows in the daytime, particularly in the afternoon. We agreed on a diet that focused on increasing proteins, beneficial fats and vegetables, reducing carbohydrates. SR was encouraged to eat 3 meals a day and avoid snacking. SR was using Salbutamol for asthma, and this may have depleted calcium, magnesium, phosphate and potassium. SR was advised on a number of supportive supplements. As the infections had been going on for a number of years, SR was advised to perform a comprehensive stool analysis which can identify multiple microbial infections and digestive and immune functionality in the GIT.
4 WEEK FOLLOW UP
SR responded well to the protocol. Her energy levels improved and she felt more able to work in the afternoons. Her fungal infections, digestive symptoms and diarrhoea showed some improvement, and she lost some weight.
SR’s test results had come back from the lab and her bacteriology culture indicated dysbiosis – no growth of Enterococcus, low level of E. coli and high levels of Streptococcus. Streptococcus overgrowth in the gut can be problematic as it acts as a reservoir for reinfection leading to sinusitis, and produces D-lactic acid which can lead to fatigue. Excess lactic acid can also disrupt the normal pH of the gastrointestinal tract, making it overly acidic, as seen by the pH result. This may damage the mucosal barrier of the intestine, leading to increased gut permeability and the leaking of bacterial by-products and partially digested food proteins into the blood which may cause allergies.
Yeast microscopy identified the presence of small amounts of yeast. Streptococcus can potentiate Candida, amplifying the severity of infection.
Fat stain was positive indicating fat maldigestion, as reported by SR. This may may due to low bile production and/or deconjugation and reduction of bile acids by Streptococcus bacteria. Deconjugated bile acids are injurious to the gut epithelium and may cause diarrhea.
Lactoferrin and calprotectin were within range, indicating a lack of appropriate immune response, as both have anti-pathogenic activity. Immune markers were high as would be expected indicating inflammation, however Candida has the ability to inactivate immune system antibodies and so lowers the body’s immune response.
HEALTH OPTIMISATION PLAN – PHASE II
Analysis of the test results indicated that the presence of Streptococcus was likely to be enhsncing the effects of Candida, hence both pathogens needed to be addressed at the same time. Eradication of pathogens may cause a die off reaction and unpleasant side effects if the the gut is permeable, hence a protective amino acid was recommended to support the gut epithelium. SR’s immune response was low hence supplementation with colostrum was advised. Colostrum is rich in immunoglobulins which provide passive immunity against pathogens. Additional supplements were recommended to help eradicate the infections
8 WEEK FOLLOW-UP
SR responded very well to the protocol. The fungal infections on her fingers and toes had significantly receded, and they were healing well. SR was enjoying higher energy levels and hence a much enhanced quality of life. The diarrhoea had stopped completely and she was having normal bowel movements, meaning that she could happily leave the house, as well increase her exercise activities. She had lost weight, was sleeping better, and had not used her inhaler or had any wheezing episodes in the whole month. She had excellent compliance to her upgraded diet, and had involved her family in healthier eating, so they were all repeating the benefits. She was particularly happy that she did not have to worry about the fungal infections anymore.
SR presented with a long standing fungal infection which began following the birth of her first child. During pregnancy the mother’s immune system switches to Th2 arm of the immune system and should switch back to Th1 post birth. If however she has remained Th2 dominant then there is likely to be a pro-Candida bias, and further, Candida enhances Th2. Antibiotic use can cause an imbalance in the bacterial flora of the GIT which can further enhance Th2 bias. Antibiotic use may have lead to strep overgrowth and the subsequent diarhhea. Often the detrimental effects of Candida are an allergic reaction to the yeast as well as from a reaction to its toxins. The Th1 cellular response is crucial to controlling Candida and supplementing with colostrum can be beneficial to shift the cellular response.
The comprehensive stool test was very useful in this case, showing that focusing solely on Candida eradication would not have had the desired impact, as the presence of Streptococcus was playing a part in the entrenchment of the infection. Dealing with both pathogens lead to a higher likelihood of eradicating the fungal infection.
Acid production by the stomach and bile synthesis in the liver play a large role in eradicating pathogens in the GIT. Optimising liver and digestive function not only protects the body from infections, but also allows more efficient extraction and assimilation of nutrients, which are required for all of the body’s cellular functions.
Candida infection is common, particularly in women, where it can flourish in the presence of high oestrogen. This case demonstrates that in some instances there may be additional pathogenic infections as well as imbalances in digestive, immune and liver function, hence focusing solely on Candida may not the whole answer. I recommend testing for all digestive complaints, as the results can provide so much information for a targeted protocol to finally overcome long-term symptoms.