The rising controversy surrounding yeast

by Daphne R. Howland

Joni K. has been feeling under the weather for about two months. Tired, cranky, achy, and mildy upset stomach were the symptoms that bothered her the most.

She recently picked up a book that described her symptoms and suggested that they were caused by something called "yeast syndrome". Following the instructions in the book, she began a low-sugar, no yeast diet. That meant no milk in her coffee, no fruit or sweets, no bread, and no wine. After a few weeks she felt more rested, and her muscle aches seemed less severe. However, she found the diet very unpalatable and decided that enough was enough. Her symptoms never returned. Were they caused by a low-grade flu, or were they due to yeast syndrome?

Joni is one of many Americans who have seized on the "yeast syndrome" as the explanation to real or perceived health problems that plague them. The idea that overgrowth of candida albicans is responsible for a variety of maladies was first proposed by C. Orian Truss, M.D., of Birmingham, AL, in the late 1970s. The Yeast Connection, a book by William G. Crook, M.D., made the theory famous in the mid-1980s. The idea remains popular today, bolstered bythe enthusiasm for alternative, or complementary, medicine.

Candida albicans is a yeast that lives naturally in the human body, most notably in the digestive tract and in women's vaginas. An overgrowth of yeast can be caused by antibiotics, by surges of hormones like those found in older versions of the birth control pill and in pregnancy, and by immune deficiency disorders such as AIDS. Yeast overgrowth is considered to be a relatively uncommon health problem. Truss, Crook and others, however, maintain that there are many common yeast-related health problems affecting many more people than the medical community appreciates.

Proponents of this notion of "candidiasis hypersensitivity" say the ailments caused by this overgrowth include--but are not limited to--fatigue, headaches, Attention Deficit Disorder, Attention Deficit/Hyperactivity Disorder, autism, muscle pain, earaches, intestinal problems (including constipation and diarrhea), intense cravings for sugar, mood swings, irritability, depression, central nervous system problems, skin problems, cold hands, multiple sclerosis, low or absent libido, painful intercourse, inability to reach orgasm, endometriosis (in women), and infertility. The list seems endless.

"The whole thing is absolute and complete nonsense," Stephen Barrett, M.D., an Allentown, PA, psychiatrist, told HealthGate. Barrett is medical editor for Prometheus books, and a publisher of consumer health care literature. He also runs a web site called Quackwatch.

Jamey Wallace, N.D. (for "naturopathic doctor") does not share Barrett's views. Wallace is a resident in naturopathic medicine at a medical clinic affiliated with Bastyr University, an accredited four- year naturopathic medical college. Researchers at Bastyr use mainstream scientific protocols to document whether and how well alternative therapies work. Wallace has experience with patients who have incorrectly self-diagnosed themselves with yeast syndrome by reading it in a book. But he says there is something to the idea.

In an interview from his home in Jackson, TN, Crook didn't dispute the lack of scientific studies supporting the yeast syndrome theory. He offers minimal small-scale evidence that anti-fungal medicine or diet seem to help small groups of people with certain disorders, but hopes that larger studies will some day back up this theories. Meanwhile, he says, his clinical experience is good enough for him.

"For a lot of polysymptomatic people, a one-month trial of nystatin [an anti-fungal drug] and a sugar-free diet can cause miraculous things to happen," says Crook.

If that sounds good to you, it doesn't to Barrett, who flags any practitioner who uses the word "miraculous" as a quack. He doesn't quibble with Crook's diet recommendations, although he is irritated by them. "Since when is good nutrition an "alternative therapy?'" he asks.

Wallace wouldn't use the word "miraculous," either. But he does believe that some patients benefit from the kinds of diets described by Crook and Trowbridge if and when they suffer from yeast syndrome. "I'm on the fence as to whether yeast is really the problem or if the yeast is flourishing because of some other problem in the G.I. [gastrointestinal] tract," Wallace says. "It's hard to say whether it's the chicken or the egg."

Even clinical practice is unusual in that the few physicians who do believe in the yeast connection don't test their patients for it. The syndrome supposedly doesn't show itself in stool samples, for example. The protocol, such as it is, is to try nystatin or other anti-fungal medication and a no-sugar, no- yeast diet for a month. At the same time, the patient cuts down on other harmful environmental factors like tobacco smoke. If the patient improves on this regimen, his or her problem was probably yeast-related, according to these practitioners.

Wallace knows of a theory that would explain why stool samples wouldn't show yeast: that the unnatural yeast growth clings to the walls of the intestines. He's unsure whether studies have proven this, though. And he cautions that, while some people may be suffering from mood disorders, low sex drive, chronic fatigue syndrome or other problems as a result of yeast syndrome, it's highly unlikely that they would have no stomach or intestinal problems. "If there aren't G.I. symptoms gas and bloating, diarrhea or constipation it would be awful hard to demonstrate that there's a yeast condition," Wallace says. "A functioning, normal healthy bowel shouldn't have an overgrowth of yeast. On the other hand, if there are a lot of symptoms, I would do the other studies, make sure there isn't a parasite or something, before I would treat for yeast."

Critics of the theory, which include mainstream medical scientists as well as naturopathic practitioners, say the quiz that Crook asks people to take is too vague, and the symptoms difficult to pinpoint. (See Dr. Crook's Questionnaire.) "Many of these so-called ailments are common, a normal part of human life," says George D. Lundberg, M.D., editor of JAMA, the prestigious journal of the American Medical Association.

Of course, improvement could be the result of an improved diet and lifestyle, or the placebo effect. Crook forbids fruit and other simple sugars for at least a month, advocates eating vegetables, lean meats, chicken, fish, whole grains and grain alternatives and tobacco cessation. Because nystatin is a mild drug and the diet could easily be described as healthy, what's the harm in trying the anti-yeast protocol?

"The biggest danger is being duped, being taken for a fool," says JAMA's Lundberg. "Another hazard is that, if there's a real disease there, there's a small but significant chance that a very serious condition will go untreated."

"Some people will feel better because they expect to feel better," Lundberg continues. "I don't want to knock that. Placebo effects matter."

Barrett, however, is not so sanguine about the placebo effect. He has a list of cases in which people have been harmed by the yeast connection diagnosis, either because their illnesses were something else entirely (in one case, hepatitis) or because they did have problems related to candida albicans but were inadequately treated, even by physicians who believe in the syndrome.

Wallace wouldn't rule out fungal medication, especially in the case of chronic vaginal yeast infections in women, but he says he wouldn't start there for digestive problems. Instead, assuming the cause of intestinal problems couldn't be pinpointed, he would prescribe herbs and an improved diet to aid in digestion. "I would usually use bitter herbs, which are very good for stimulating digestive secretions. We tend to neglect the bitters, and those taste buds initiate the digestive process and keep everything flowing," he says. "There are natural ways to optimize bowel function."

When HealthGate asked Crook what to do if a physician doesn't diagnose yeast theory, he lamented the dearth of "physicians who believe." He urges people to buy his book, to find a physician, chiropractor, or anyone who can write a prescription for anti-fungal medication, and to try to persuade their health care provider that their physical problems are yeast-related.

In an era when patients need to be assertive about their health care, this is not necessarily a radical message. Barrett says he is all for patient empowerment, but cautions against quackery. So the key question for patients is: "How do you know?"

One way is to thoroughly research any health care ailment or cure that is overly touted, either in the mainstream press or elsewhere. Medical information web sites can be difficult to sort out because even well designed, official-looking ones are not necessarily affiliated with good science. Mainstream medical associations are trustworthy because they do have solid science behind them. The American Academy of Allergy, Asthma and Immunology, for example, has sorted through the research and presents their position on yeast and candidiasis hypersensitivity: "The concept is speculative and unproven."

In consumer health care stories, like this one, look for mentions of studies that back up medical claims. As Barrett says, words like "miraculous" are not medically useful terms. In fact, most reputable health care practitioners and scientists will shy away from making outlandish claims, even for treatments they do have confidence in.

Nurture your relationship with your own health care provider, whether a physician, a nurse or other practitioner. If they don't have much confidence in a theory or treatment, ask them to explain why. Any health care provider should be able to explain themselves and their views to their patients. Finally, find out what the down sides are to any treatment. Herbal remedies or strict diets aren't necessarily benign; they can be quite harmful if misused.

For the yeast connection theory to join other originally controversial medical theories into the mainstream, studies will have to prove Truss, Crook and their followers correct. Perhaps some day they will. JAMA's Lundberg isn't holding his breath: "It's mostly a big hullaballoo about nothing."