Twenty years after Orion Truss discovered candida, many practitioners now believe the story is more complicated and that natural alternatives are better than anti fungal drugs.
It is now almost 20 years since C Orian Truss, an American clinician, first introduced the world to an unlikely medical monster a yeast fungus in the gut which, he said, was responsible for a vast range of human ailments. Since then, the name of that tiny yeast, Candida albicans, has become a watchword for the many millions of people who have sought unorthodox answers when conventional medicine has failed them.
Today, two decades on, "candida" has in a sense come of age, but has maturity brought wisdom? Some would say no, and that the syndrome has turned out to be much more complex than Truss thought.
For conventional doctors, "candidiasis" still means primarily a localised invasion of the vagina or mouth, commonly called "thrush". Few of them have taken on board Truss's radical notion that candida can also proliferate in the gut and cause "a syndrome of almost unlimited scope", in the words of US physician Richard Passwater. Traditional medical prejudice and conservatism may be the reason, or it may be, as some specialists like Dr Keith Eaton believe, because the "candida syndrome" has not yet been proven and may be a misnomer.
Recently, some clinicians have begun to question the whole idea. "Although it is possible that Candida albicans may be the cause, it has never been proved to be the culprit," says Dr Keith Eaton, a leading specialist. Naturopath Harald Gaier, director of medical research at London's Hale Clinic, agrees. "Clearly, other similar organisms such as Candida utilis, Torulopsis glabrata or even Crytococcus hystolticus may be responsible, or indeed parasites like Giardia
lamblia or Blastocystis hominis," he says.
Dr Eaton has coined the term "Fungal type Dysbiosis", but Dr Gaier favours the even less specific "Dysfunctional Gut Syndrome". Both agree that the primary diagnosis is through a test that shows up abnormal production of ethanol in the gut. This, according to Dr Eaton, is the only strong evidence pointing to yeast as the culprit.
"We still have no proof, however, that it's Candida albicans. Truss claimed that because anti fungal drugs worked, the syndrome must have a fungal cause; he then jumped to the conclusion that it must be C albicans. Neither he nor anyone else has come up with a shred of evidence to support it. The fact that anti fungal drugs work could be explained by the fact that they are good gut wall stabilisers; they also kill bacteria and parasites. That's why I call it 'fungal type dysbiosis' (FTD) it looks like a fungus is involved, but we can't be sure."
Dr Eaton believes bacteria may be at least partly responsible. He has found elevated levels of hydrogen in the breath of his "dysbiosis" patients, and hydrogen is produced by bacteria, not yeast. Another reason for the symptoms could be an allergic reaction to bacteria or yeast. Allergic reactions produce an excess of histamine, which metabolises into histadine and can be measured in the urine. In a study on 21 patients with "dysbiosis", Dr Eaton showed that they had the similar levels of histadine to patients with food allergy (JNutr Biochem, Oct 1998).
In fact, he has found some patients with FTD can be helped by food intolerance treatments, such as low dose neutralisation and enzyme potentiated desensitisation.