What Is Candida? 5 Facts You May Not Know

Improve Your Overall Microbiome Balance to Tackle Gut Candida

• Candida is a Common—Even Friendly—Gut Resident|
• Tests for Intestinal Candida Aren’t Helpful|
• Candida Overgrowths Don't Usually Happen in Isolation|
• You Don’t Have to Eat a Low-Carb Diet if You Have Intestinal Candida|
• Antacid Use Could Be Making a Candida Condition Worse|
• A 4-Step Plan to Beat Candida by Bringing Your Microbiome Back Into Balance|
• Candida Knowledge Makes For More effective Treatment|

So, what is Candida? Candida is a yeast, a type of fungus, that can populate our skin, digestive tract, and reproductive system, and it may sometimes cause infections. Symptoms like bloating, gas, diarrhea, skin issues, genital and vaginal yeast infections, and depression may all point to Candida overgrowth. 

However, we now know there are several myths and misconceptions around what Candida is and the role it plays in the body. In the light of more recent research and new knowledge about the microbiome, it’s likely that Candida overgrowth of the gut has been over-diagnosed.

That’s not to say that intestinal Candida overgrowths can’t happen (they can, and do, in both the small intestine and bowel). But over-focusing on this specific microorganism makes it easy to miss the bigger picture: the health of your gut and its diverse ecosystem of microbes.

In this article, I’ll correct some of the inaccuracies around Candida. Then I’ll share a simple research-based plan for getting rid of excess Candida in the intestines while bringing your gut microbiome back to balance.

Before we begin, though, it’s helpful to realize that Candida is often the scapegoat that takes the blame for poor gut health and poor diet in general. It’s good to keep this in mind as we dig into five lesser-known facts about Candida, starting with the misconception that this yeast is always a bad guy.

Fact 1: Candida is a Common—Even Friendly—Gut Resident

Candida is a yeast (a type of fungus) that resides in most people’s guts, usually without causing problems. In a recent study of stool samples, researchers found Candida albicans (the most common Candida species in humans), in the stool of about 577 (83%) of 695 healthy people [1].

This suggests that Candida is a normal part of the ecosystem of microbes in our gut, and it may even be beneficial when it coexists peacefully with other microbes.

So, how did Candida get such a bad rap? One reason could be that when Candida infections do occur, they can cause some pretty well-known and miserable symptoms. For example, both vaginal thrush (vaginal candidiasis) and oral thrush (oral candidiasis) are caused by a Candida infection (usually Candida albicans). Candida can also cause invasive candidiasis, a severe infection (sometimes life-threatening) that occurs in very sick patients and those with a weakened immune system, affecting the blood, heart, brain, eyes, and bones.

Given that Candida can cause these unpleasant conditions, it’s easy to assume that if this type of yeast is in your intestine, it must be producing your gut symptoms, too.

On the more cynical side of things, I’ll also point out that there’s a big market on the internet for Candida testing kits and Candida-killing supplements. Those who are pushing these kits have a vested interest in making you believe Candida is the main factor behind your symptoms.

In reality, what’s important to your gut health is the overall balance of microbes in your gut, not just whether Candida is present. In particular, having a robust and diverse population of bacteria in your gut is what keeps Candida numbers in check [2].

In other words, if you can focus on keeping your microbiome as a whole, healthy ecosystem, you don’t need specialized actions to get rid of intestinal Candida.

Fact 2: Tests for Intestinal Candida Aren’t Helpful

I pretty much never use stool tests to quantify intestinal Candida for three reasons. 

First, Candida is commonly found in the stool of healthy people, as we have already seen, and is no cause for alarm [1]. 

Second, there are no established standards for what a “normal” or “high” level of Candida is in the gut. So, two labs might measure the same level of Candida in your stool, but one may define your level as normal, while the other might label it as high.

For example, scientific researchers studying Candida populations in the gut have suggested that between 10,000 and 100,000 colony-forming units (CFU) indicate a high amount of Candida [3, 4, 5, 6]. In contrast, functional medicine labs may not provide a normal value, or they may suggest that anything over 5,000 CFU is too much [7]. 

In other words, there is no standard agreement on what is high and what isn’t, so it’s better to use your symptoms as your guide [8]. 

The third reason I don’t use stool tests to measure Candida is that there’s a lot of inconsistency in test results from lab to lab. For example, at the clinic, we did a test in which we split one person’s stool sample in two and sent each half to a different testing center. The results were telling. In the same stool sample, one lab found an overgrowth of Candida, while the other lab did not. There were also huge differences reported in the amount of other species in the stool, including Akkermansia, Klebsiella, and Pseudomonas.

Just as a footnote here, urine and blood test tests that check for d-arabinitol (a Candida-made sugar that we excrete in the urine) have partial validity for diagnosing  invasive candidiasis, a serious infection [9, 10, 11]. However, these tests are not validated for assessing intestinal Candida.

To recap, with gut Candida tests being so inaccurate and unreliable, I no longer use them. Instead, I recommend that my patients use their symptoms as a barometer to help us guide their treatment. In fact, research shows that intestinal Candida overgrowth and symptoms may correlate closely [8]. 

But that’s almost beside the point: that gut symptoms indicate a problem with the whole intestinal ecosystem, of which, as you’ll find out in the next section, Candida is simply an interdependent part.

Fact 3: Candida Overgrowths Don’t Usually Happen in Isolation

When we help patients at the clinic, we often find that Candida overgrowth is a symptom of a more generalized problem with their microbiome health. 

Although this observation is anecdotal, we also have data supporting the idea that microbiome imbalances occur together, not singly. 

For example, one study involving 150 participants with chronic gastrointestinal (GI) symptoms linked with overgrowths found that 34% of the group had a mixture of small intestinal fungal overgrowth (SIFO) and small intestinal bacterial overgrowth (SIBO) [12]. In other words, Candida yeast and unhealthy bacteria were commonly overgrowing together in the small intestine.

A helpful way to think about this is that it doesn’t really matter if you have SIFO, SIBO, or some other type of gut imbalance. If you’re having a host of gut symptoms, it’s likely your microbial ecosystem as a whole has shifted toward a more unhealthy composition. The way to resolve this is to improve your gut health and general health without getting lost in trying to treat one specific gut microbe. Usually, if one is out of balance, it means the others are, too.

Working on your underlying gut health will help bring your whole gut microbiome back into balance, which prevents symptom-causing overgrowths and negates the need to find a specific culprit.

Fact 4: You Don’t Have to Eat a Low-Carb Diet if You Have Intestinal Candida 

The idea that you have to eat a low-carb diet if you have intestinal Candida—even if you find low-carb doesn’t suit you—is quite entrenched within the field of functional medicine. I’ve met patients who doggedly stuck to a low-carb diet that clearly didn’t work well for them, based on a Candida overgrowth stool test from 1–3 years prior! 

I find this disturbing because we know that gut Candida tests are inaccurate and unhelpful and, as I’m about to explain, low-carb diets are unnecessary.

Case in point: In a study of Candida treatments, a whole-foods diet (with grains, cooked potatoes, and brown rice) plus antifungal medication (nystatin) were twice as effective as nystatin plus a regular diet including more added sugar and processed foods [5]. That suggests the whole-foods diet played a significant role in correcting the Candida overgrowth, even though it included unprocessed carbohydrates. In other words, not all carbohydrates are bad if you have intestinal Candida!

Sure, the helpful diet did restrict certain carbs (sugars and refined grains and starches), as well as alcohol and meats, other than fresh fish and lean chicken. That this diet helped treat Candida makes sense because we have evidence that a Westernized, processed diet can encourage this fungus to grow [13]. 

The main point here is that you don’t need to be on a super-restrictive “anti-Candida” diet that excludes all carbs. For most people, simply shifting to a healthy diet that’s low in processed foods and added sugars is enough. 

I’ll touch more on the types of diet that can help to rebalance your microbiome and keep Candida in check, with the 4-point plan below.

Fact 5: Antacid Use Could Be Making a Candida Condition Worse

Stomach acid-reducing medications for heartburn and gastroesophageal reflux disease (GERD) are also implicated in intestinal Candida overgrowths and infections. These medications include antacids (e.g. Tums) and proton pump inhibitor medications (e.g. omeprazole).

You need a certain concentration of stomach acid to kill excess bacteria and fungi and prevent them from populating your intestines. But acid-lowering medications raise the pH of your stomach contents, which can allow too many bad bacteria and yeasts to survive the stomach, seeding overgrowths further down the GI tract [12]. 

If you absolutely have to take acid-lowering medications (something to discuss with your healthcare provider), you may have to be extra scrupulous with the 4-step anti-Candida plan below. You may need to head to step 4 (antimicrobials) quicker than would normally be the case.

Other Potential Causes of Candida Overgrowth

Though sometimes unavoidable, antibiotic medications are a well-understood factor in the overgrowth of Candida in the gut. Basically, when you lose beneficial bacteria during antibiotic treatment, Candida levels can start to rise [6]. 

In addition to a sedentary lifestyle and highly processed diets, preventable factors that can contribute to the growth of Candida in the gut include smoking and excess alcohol intake [14, 15, 16]. 

Chronic stress is a less preventable, but manageable risk factor for microbial overgrowth and other microbiome imbalances (dysbiosis) [13, 17, 18].

I’ll also note here that oral contraceptives for birth control can increase your risk of vaginal candidiasis [19], which may increase your risk for intestinal Candida infections [20].

Let’s now look at how to fight Candida overgrowths in the gut by making your gut microbiome healthier. 

A 4-Step Plan to Beat Candida by Bringing Your Microbiome Back Into Balance

From my 10 years of experience with patients who have gut symptoms suggestive of Candida overgrowth or other microbial imbalances, I find this 4-step plan is the most effective. It works so well because it tackles fungal overgrowths by strengthening the health of the microbiome overall. 

Each person will respond slightly differently to these four steps, and not everybody will need all of them.

The important thing is for you to let your symptoms guide you. An improvement in symptoms usually correlates closely with healthy changes in the gut microbiome, including a reduction in excess Candida [8]. 

Your progress may not be linear, but if you keep a diary of your symptoms, look for small improvements that add up over a couple months or so.

Step 1: Make Healthy Diet and Lifestyle Changes

When it comes to Candida, diet and lifestyle changes are the treatment options that make the biggest impact. In particular, moving away from processed foods with lots of added sugar is very helpful.

However, I’m not prescriptive about which diet you should follow, since different diets work for different people. And as we’ve already discussed, you don’t necessarily have to eat a low-carb diet. 

But if you want to know where to start, two whole-food options that are generally good choices are a Mediterranean-style diet and a Paleo-style diet.

The Mediterranean diet (fresh vegetables, lean meats, oily fish, nuts, olive oil, and whole grains) is low in processed foods and sugar and has been shown to be a microbiome-friendly diet [21]. It also has benefits for the cardiovascular system [22], is protective against colon and breast cancer [22, 23], and may have benefits for mental health [24].

Many of my patients with suspected Candida overgrowth also do well on a Paleo diet, particularly if their gut symptoms are more pronounced.

Like a Mediterranean diet, a Paleo diet meal plan reduces or eliminates processed ingredients and added sugars. However, it also cuts out potential trigger foods like dairy, gluten, and soy that might promote inflammation, gut dysbiosis, and Candida overgrowth [25, 25, 26, 27, 28, 29, 30]. 

In tandem with diet changes, incorporating physical activity into your life is important. Exercise increases gut microbial diversity [31], and more healthy gut bacteria means better control of Candida.

A combination of resistance exercise (weights) and aerobic exercise will increase your chances of living longer and more healthily in general [32]. The optimum level of aerobic exercise to help you live longer may be higher than the official guidelines of 150–300 minutes per week of moderate physical exercise (e.g. walking or jogging) or 75–150 minutes a week of vigorous physical activity (e.g. running) [33]. 

If that sounds daunting, just remember that any movement is better than none, and you can always increase your intensity or duration over time.

Another important lifestyle hack for helping your gut microbiome is to reduce stress, especially if you suspect you have a Candida [34]. Of course, exercise is a great way to reduce stress while also benefiting the microbiome. Other stress-busters that can improve gut symptoms include meditation [23], yoga [35], and especially time in nature [36, 37, 38]. 

Once you’ve made strides to improve your diet and lifestyle, you can double down on any remaining symptoms suggestive of Candida overgrowth by taking probiotics.

Step 2: Probiotics

Probiotics are a perfect fit for tackling Candida overgrowth symptoms because they have antifungal and anti-inflammatory properties, and they can increase the number of beneficial bacteria that keep fungus in check. Probiotics may also help to heal a leaky gut and promote a healthy immune response [39, 40, 41]. In some cases, probiotics can be as effective as common antifungal medications for treating fungal overgrowths [42, 43]. 

There’s no need to seek out a specific strain of probiotic that’s best for dealing with anti-fungal infections—the evidence doesn’t yet suggest one is better than another. However, research does suggest that a multi-strain approach is best [44, 45, 46], and we see this borne out in our patients with suspected Candida.

In the clinic, we use a triple-therapy protocol that comprises a blend of Lactobacillus and Bifidobacterium strains, Saccharomyces boulardii (a beneficial yeast), and a soil-based probiotic, typically for 2–3 months. 

If you still have gut symptoms after making changes to your diet and lifestyle and using probiotics, the next step is to give your digestive system a short break with an elemental diet.

Step 3: Elemental Diet

An elemental diet is a tool to help you to starve any remaining Candida and allow residual sensitivity and inflammation to subside. This hypoallergenic, anti-inflammatory meal replacement provides you with fully or partially broken-down nutrients to give your small intestine a rest. Having to work less hard to get nutrients helps to fast-track gut repair and quickly restore a healthy immune system response. An elemental diet is one of the most effective ways to reset your gut.

While we don’t have research on using an elemental diet for Candida overgrowths specifically, we do have good data showing it can benefit digestive health conditions related to microbiome imbalances, like inflammatory bowel disease [47, 48] and small intestinal bacterial overgrowth [49]. Knowing that, it’s fair to assume that an elemental diet may be useful for fungal overgrowths, too.

At the clinic, we’ve found that many people do well with a “half-elemental diet,” in which you replace one or two meals a day with an elemental shake and eat a healthy diet the rest of the time. You can give this a try if you feel like a shake for every meal is a bit too much. You can also do a 24-hour full elemental diet, followed by a half-elemental diet. Essentially, the elemental diet is a highly flexible and effective tool for gut issues. 

Typically, for my patients with overgrowths, I coach them on using an elemental diet for 1–3 weeks. If you’re doing an elemental diet on your own, 4 days is the maximum term I would suggest. If you need to go longer, please only do so with the supervision of a practitioner. If you still have symptoms suggestive of Candida after your elemental diet term, then I would move on to the next step.

Step 4: Antimicrobials

Lingering gut symptoms after you’ve incorporated the first three steps suggest a stubborn case of microbial imbalance that needs an antimicrobial nudge. Antimicrobials include a variety of plant extracts and over-the-counter or prescription medications that can knock out bad bacteria, infectious microbes, and fungal overgrowths [50, 51]. 

Natural, plant-based antimicrobials with potential antifungal effects include: 

• Caprylic acid (a fatty acid that occurs naturally in coconut oil and breast milk) [52].
• Artemisinin (from sweet wormwood) [53, 54, 55, 56]
• Thymol and carvacrol (in oregano oil) [57, 58] 

Conventional antifungal medicines include fluconazole, miconazole, clotrimazole, and nystatin. Oral tablet or capsule versions are available for intestinal or systemic infections. They can also come as ointments or creams for fungal infections on the skin, or in suppositories for vulvovaginal candidiasis. 

In general, I prefer to use herbal antimicrobials, which tend to have a broad-acting pharmacology, and therefore contribute less to the rise of antifungal- and antimicrobial-resistant organisms [59, 60, 61]. They are also less likely to have unpleasant side effects [62] or negatively disrupt the gut microbiome [63].

Antimicrobials with antifungal actions can be useful to get rid of intestinal Candida overgrowths. However, I recommend them as a final resort because it is so important to prime the whole gut ecosystem with foundational support first, via steps 1–3. 

The way to look at it is that diet, lifestyle, and probiotics by themselves can often be enough to foster the beneficial bacteria that keep Candida in check. Herbal antimicrobials are certainly something to consider with your healthcare provider as an extra help, but only when the first supportive elements are in place.

Candida Knowledge Makes For More Effective Treatment

Candida is a natural resident of the gut microbiome that can live peacefully alongside other gut microbes but will sometimes overgrow because of an imbalanced diet and lifestyle.

If you suspect you have an intestinal Candida overgrowth, fixating on special anti-Candida diets or getting your Candida levels down to a particular level as measured by a stool test isn’t the way forward. The only reliable way to tackle it is to bolster your overall gut health. 

If you go through this process but still haven’t completely nailed your Candida symptoms, we are here to help. Check out my book Healthy Gut, Healthy You for my complete Great-in-8 gut healing protocol, or contact us at the Ruscio Institute for Functional Health to schedule an appointment. 

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

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