"Doctor," sighed the middle aged woman sitting atop my exam table, "Why do I need to read things three or four times in order to have them register only to discover that the next minute I forget what I was reading? It's gotten bad enough that my husband just gave me a greeting card that says 'Of all the things I've lost in life, I miss my mind the most.'" She paused before continuing: "When my other doctor told me my symptoms were all in my mind, I asked him to help me find it." She chuckled softly, but without much of a twinkle in her eyes and with a weariness that told me clearly that her's was a chronic and very debilitating problem. How far back does her story go? It winds way back to the beginning, for in the beginning was the yeast. We are all born with yeast. It manifests typically in the form of Candida Albicans, a common yeast that lives on us literally and physically. Yeasts are saprophytes meaning they consume dead tissue and the tissue they graze on is remnants of our skin, our gastrointestinal tract, our esophagus, our mucosa and our small intestine. The critical issue here is that, while it is OK for the yeast to live ON us, yeast ought not live IN us. "Now how," you might ask, "can yeast live in our intestines and not be in us?" The answer, no mere semantic twist, is that our intestines themselves (and all their contents) are not properly inside us but rather they wend their way through us. In is not within any more than sticking your finger through a donut hole does not mean putting your finer in the donut. (Think about it.) After all, we put things into our intestines that would kill us if they ever made it though our intestinal wall and into our blood stream. Severe allergic reactions and perhaps death would result from mainlining carrot juice or other undigested foods. The alchemy that takes place within the GI tract is designed to separate the nutrients (which are safely absorbed) from the waste products and toxins (which are eliminated). Yeast can flourish in the GI tract but ought not proliferate in the blood. But they do. Like your worst sci-fi horror story where toxins leach out from a supposedly secure place and wreak havoc, so too do yeast metamorphoses and escape to cause a systemic infectious process called Candida Related Complex (CRC). With a decline in the potency of our immune system, yeast cells, which optimally live in an eco-system balanced with "friendly" bacteria, tend to overwhelm other micro-organisms and rampage. In so doing, the yeast cells change from a harmless round spore happily munching their share of fat and sugar to thread-like germ tubes (hyphae) which can puncture the gut wall and spread powerful toxins into the blood (systemic infection) which potentiate allergic, infectious or other intoxicating reactions. One of my patients literally failed a breathalizer test without having consumed any alcohol; his overgrowth of yeast were energetically converting sugars and carbohydrates to ethanol! (Brewing, after all is a simple and ancient trick our ancestors learned from cooperative yeast). So how do we "contain" this potential pathogen in a docile form? How can we keep yeast in a friendly spore form with no thought of colonizing anywhere else other than the intestinal tract and with no thoughts of spreading toxins? Well, for one thing, avoid inappropriate antibiotic use, try not to become a diabetic and overall, cultivate a strong immune system. Immunocompromised people are targets for this opportunistic pathogen. Anything that lowers the vitality of the immune system creates a "welcome mat" for candidiasis. "What's wrong with antibiotics?" you might ask. Well, nothing if used appropriately. Remember, antibiotics work only against bacteria. They don't faze the yeast. Since yeast compete for GI turf with bacteria, excessive or indiscriminate antibiotic use, by killing only bacteria, tips the scales in favor of yeast which proliferate and are off to the races. You just bought yourself at least 6 months of candidiasis. A classic example is Scott who dutifully took tetracycline for acne between the ages of 16 and 24. Eight years of antibiotics. Count em. When he first walked into my office I could smell him coming. Consequently, I never prescribe antibiotics without offering an antifungal agent at the same time - especially to elderly or immunocompromised people. This way we try and keep a healthy balance between yeast and bacteria in the intestines. Just the way we were designed. Everything in moderation. Aside from antibiotics, what else sets one up for candidiasis? Again, think what lowers your immunity. Stress. Lax exercise habits. Toxins such as excess sugars and fats as well as nutritional deficiencies of essential fatty acids, amino acids, complex carbohydrates, vitamins and minerals. These in turn may be caused by achlorhydria (too little stomach acid) which is rampant in America today. inadequate stomach acid renders the entire GI tract too alkaline and therefore inhospitable to lactobacillus acidophilus, the primary competition for yeast. (As the name suggests, Acidophilus (from the Greek "philo" meaning "lover" ie "acid lovers") needs acids to thrive. With inadequate stomach acid, acidophilus, the main competition to yeast can't mount much resistance. Other "risk factors" include being on the pill since estrogen allows yeast to thrive also. A diet high in yeast products, sugar and alcohol spells trouble while a diet high in fiber and water spells relief. This means one needs to avoid substances that encourage yeast to proliferate (junk food, sugar, alcohol). After all, you don't "catch" Candidiasis, you "grow" it. You encourage it, cultivate it and pamper it. Once it gets started, the toxins released from rampaging yeast further hobble the immune system accelerating the downward spiral. What are the symptoms of localized candidiasis? Oral thrush looks like a white cheesy plaque loosely adherent to the inside if the mouth. Diaper rash is frequently yeast and had a red colored, mottled circular pattern. Vaginal candidiasis is a thick curdlike discharge smelling stale and itching terribly. These are all readily identified by first year medical students. However, systemic infections of opportunistic yeast are more elusive and require a more wizened clinician. Blood cultures are routinely drawn for bacterial infections but not so for fungal infections. An old saying in medicine is "If you don't look for it, you won't find it." Most doctors still don't think to rule-out Candid Related Complex (CRC). The disseminated infections are hydra-headed and baffling to behold. Virtually every organ (heart, kidney, lungs, esophagus, central nervous system), all joints are at risk (fungal arthritis) and even the eye is vulnerable (Candida enopthalmitis). Symptoms are non-specific enough that many a sufferer of systemic candidiasis found themselves lying on their back in a psychiatrist's office wondering if their mother really is the cause of their kidney or heart pain. One poor soul was considered depressed by her internist was referred to me for psychotherapy only to find when I tested her blood for fungus that her liver was infiltrated with candida and her liver enzymes were sky high. Remember: When all else fails "Think fungal". The following symptoms may serve to jog your memory: gas, bloating, constipation; diarrhea, colitis, watery eyes, hayfever, earaches, hives, vaginitis, menstrual irregularities, PMS, endometriosis, cystitis, kidney and bladder infections, localized itching and burning. On a more esoteric level, the central nervous system can also become imbalanced resulting in depression, anxiety, phobias, misdiagnosed autism, memory loss and headaches. However, most commonly, the presenting symptoms are generalized fatigue, lack of energy and loss of libido. Symptoms aside, how can you be sure you have candida? Stool cultures for yeast are not definitive nor are fungal cultures or anti-candida antibody tests. These, if positive raise one's suspicions, but authorities in the field recommend trial treatment with an anti-fungal agent as the only way to learn if you HAD candidiasis. If the diagnosis of candidiasis is tricky, treatment is almost crazy-making. Options are myriad. Some kill the candida, many help, most don't and all try the stoutest of hearts. No pill prevents recolonization. Only diet does that. Diets lowing sugar, high in fiber, digestive aids and acidophilus as well as therapies designed to clear up allergies and tighten up the lining of the digestive tract. Most regimens last six months at the minimum. Everyone agrees that spring cleaning is a good idea. So is home renovation or, for that matter, any change for the better. No argument there. However, when you clean up a yeast infection, like any other effort to improve yourself, one pays a price. No one wants to breathe the home air during spring cleaning nor live in a home being renovated but unfortunately, one can't "move out" even temporarily during the battle against yeast. Instead, whether one uses the conventional anti-fungal drugs Nystatin, Ketaconozole, Amphoteracin B, Diflucan or the more appetizing selection of oregano oil, tea tree oil, Pau D'Arco, Artemesia and Aloe Vera, one must gird one's loins. The first setback is actually a good sign: the dreaded Herkermer reaction aka the "die off reaction". 85% of people "spring cleaning" their yeast suffer depression, nausea, constipation or diarrhea and headaches when the dying yeast dump their toxins into the blood stream. (Unless that is, they swallow adequate activated charcoal which, like a sponge, soaks up and neutralizes the toxins.) The die off reaction is a good sign because it suggests that you are winning the battle. Keep sweeping! To your health!