Candida and Proteolytic Enzyme Therapy
Tara Levy, ND
Every naturopathic doctor is familiar with the following list of complaints: flatulence, bloating, fatigue, “foggy” headedness and irregular bowel movements. We order stool tests, suggest dietary changes and explore lifestyle factors. We may hope it’s something simple, something we can affect quickly – maybe HCl or enzymatic deficiency. And then those stool results come back, and we know our work is just beginning.
Candidiasis is one of the most commonly occurring imbalances in the digestive tract. Candida albicans is a yeast-like fungus that normally lives in healthy balance in the body. When the balance is upset, or when conditions favor growth of the yeast over the normal flora of the intestine, an overpopulation of yeast results. Candida overgrowth is also associated with other opportunistic organisms, such as Klebsiella and Staph aureus (Boikov et al., 2005). Treating these co-infections, as well as treating candida overgrowth alone, can be a long road. Luckily, more tools are available to the practitioner that can help make this road a little shorter.
Plant-based digestive enzymes have been used for many years to support gastrointestinal function. Though primarily used for their aid in digestion (supplementing the digestive enzymes manufactured in the pancreas), recently the benefits of enzymes have been seen in fighting candida and other causes of dysbiosis. Specific enzymes have destructive activity on the candida cells, rendering them inert and allowing the body to clear the debris and infection more effectively. The enzyme Cellulase is thought to be able to digest the cell wall of the fungus (the Candida), and Protease enhances the elimination of the protein contents inside the fungal cell. Cellulase is also thought to contribute to the digestion of fiber in the intestines. It is thought that certain types of excess fiber in the digestive tract may contribute to candida overgrowth.
Intestinal permeability also contributes to the virulence of Candida albicans in the GI tract, as the quality of intestinal cells and the intestinal surface can play a role in determining the adherence of the Candida (Tsay and Samaranayake, 1999; de Repentigny et al., 2000). Strengthening the digestive tract mucosa with amino acids and amino acid derivatives, such as glutamine, NAC and N-acetyl glucosamine, and herbs such as ulmus and althea, can greatly enhance the effects of an anti-fungal treatment.
Case Study 1: Patrick
Patrick, a 71-year-old man, started seeing me after being diagnosed with chronic prostatitis and having little success with mainstream treatment. After months of receiving antibiotics from his medical doctor, his condition only worsened. He came to see me after three months of antibiotic therapy. He was experiencing sensitivity to sugar and alcohol, a generalized ‘brain fog’ feeling, and frequent gas and bloating, in addition to the symptoms of prostatitis. To confirm my suspicion of Candidiasis, I performed a microbiology stool test on Patrick, which revealed an overgrowth of candida and low levels of bifidus.
Within a few months, Patrick’s candidiasis reached a manageable level. Patrick strictly followed a Candida diet, and also took probiotics (HMF strain powder, ¼ tsp. 2x daily) and antifungal herbs – first, caprylic acid (1 capsule 3x daily) for one month, followed by a combination formula of uva ursi, oregano, wormwood, olive leaf, berberine, grapefruit seed extract and black walnut (2 capsules 2x daily) for another month. His prostatitis resolved, but occasionally it would flare up, along with the other symptoms, if he did not keep his diet and lifestyle in check. Once we added intestinal support powder (combination of L-glutamine, N-acetyl glucosamine, DGL, ulmus, althea, MSM and aloe; 1 tsp. 2x daily), his symptoms were even less frequent.
A few months later, Patrick suffered a tooth infection that was treated with antibiotics. During the course of antibiotics, his Candida symptoms flared up. I tried a new course of treatment: In addition to the same probiotics and Candida diet guidelines, Patrick began taking a proteolytic enzyme formulation (2 capsules 3x daily) designed to break down yeast and the food yeast thrives on.
At a follow-up visit one week later, Patrick reported that his symptoms were much better. This was the fastest turnaround he had ever experienced. Patrick kept the same dosage for one more week, then decrease it to 1 capsule 2x daily for another two weeks. Patrick’s symptoms over the last two weeks of enzyme therapy and probiotic administration ameliorated until they completely resolved. Today Patrick remains symptom free.
Case Study 2: Carrie
The first office visit from Carrie, a 38-year-old woman, brought complaints of fatigue, constipation, joint pain and flatulence. Her history was significant for a host of viral infections, including Guillain-Barre and EBV, which had been treated several years ago with multiple rounds of antibiotics. Stool testing helped determine that she had intestinal co-infection of yeast and klebsiella.
Her symptoms resolved well with an herbal combination formula of uva ursi, oregano, wormwood, olive leaf, berberine, grapefruit seed extract and black walnut; intestinal support (product containing L-glutamine, N-acetyl glucosamine, DGL, ulmus, althea, MSM, and aloe; 1 tsp. 2x daily); probiotics (HMF strain powder; ½ tsp. daily); and a dysbiosis diet. However, like Patrick (in case study #1), she had to remain quite strict with her diet to remain symptom free.
Several months after the initial resolution of symptoms, Carrie suffered a back injury and went completely off her diet. After several weeks, her initial symptoms returned, worse than before. This time, her protocol consisted of the same intestinal support formula and probiotics along with an enzyme formulation containing high-dose protesase and cellulase (2 capsules 3x daily) simultaneously. Within one week, Carrie noticed a significant change in symptoms, and she continued the protocol (with decreasing dosages) for one more week. Over the next two months, Carrie increased foods in her diet, and she is now symptom free.
Boikov SS et al: Association of Candida albicans fugi with some opportunistic microorganisms in intestinal dysbiosis in patients of different age groups, zh Mikrobiol Epidemiol Imunobiol 2:65, 2005.
Tsang CS, Samaranayake LP: Factors affecting the adherence of Candida albicans to human buccal epithelial cells in human immunodeficiency virus infection, BR J Dermatol 141(5):852-8, 1999.
De Repentigny L el al: Characerization of binding of Candida albicans to small intestinal mucin and its role in adherence to mucosal epithelial cells, Infect Immun 68(6):3172-9, 2000.
Tara Levy, ND, received her B.A. from Vassar College and her doctorate in naturopathic medicine from Bastyr University. She currently is the medical director of Tara Natural Medicine, a family practice with offices in Concord and Berkeley, Calif. Dr. Levy is the immediate past-president of the California Naturopathic Doctors Association.