Patients are made worse by anything which can be fermented, such as starch and sugars; they react to foodstuffs containing yeast or mould (bread, wine, mushrooms etc); they are often ill in mouldy or musty surroundings (old buildings, woodlands or animal byres); some are even sensitive to damp weather, when moulds are sporing freely; often there are accompanying infections of the fungus type, including athlete's foot, or other skin infections, such as tinea and epidermophyton.

Remember that moulds and their relatives are individually quite toxic; it would be quite surprising if we were not made ill by contact with them. Many cases of so called candidiasis may not be so much an allergy as a poisoning.

Diagnosis

We are plagued by the lack of a suitable diagnostic test to show whether or not a patient has candida. Some alternative practitioners use applied kinesiology techniques, but these tests have not gained acceptance by the allopathic medical community. Until we do come up with a scientifically sanctioned test, practitioners of conventional medicine must exclusively rely on clinical history.

The lists of symptoms often published as a weathervane of a person's "candida quotient" are not reliable guides to candida infection or that of any other mould. These simply reflect a body under stress, rather than any single specific condition. The symptoms usually listed could be typical of food allergy, ME or a host of other ailments.

In my experience fatigue is an almost constant accompaniment of candidiasis and mould problems, as is depression or mood swings. However, four symptoms almost always are present in the "yeast syndrome": craving for sweet foods, a poor tolerance of alcohol, chemical sensitivity and bloating. Three or four are a sure sign of candida particularly a craving for sugary foods.

Researchers in the UK are trying to establish a valid gut fermentation test. The idea is to take a resting blood alcohol level and then repeat it some hours after a sugar feed. If alcohol appears in the blood, this suggests fermentation is going on. But it doesn't tell us what is doing the fermenting.

One way we might pinpoint the cause of the yeast syndrome is to look for a wider range of fermentation products. At the moment Biolab in London is testing for short chain fatty acids and other alcohols (see box, p 3). The advantage of this newer test is that it doesn't need "before" and "after" samples, so it is easier to do. It is too early to say if these tests will have any meaningful use in terms of treatment.

Treatment

A successful anti mould programme must include efficacious restoration of bowel flora. That means removing the offenders and replacing them with "friendly" bacteria. Several steps are necessary: killing off the moulds, avoiding sugars, minimizing further contact with mould and yeast, especially in the diet, and, lastly, recolonization with suitable flora.

The most important step, to my mind, is medication with suitable anti fungals. Polyene antibiotics have revolutionized this field. They are effective against yeasts and filamentous fungi. Nystatin is the most popular. It is highly toxic but because it isn't absorbed when taken orally, it is well tolerated. The usual doses are in the range of 1,000,000 units four times a day (1,000,000 units = quarter of a teaspoon). Capricin, that is, caprylic acid, often advocated as an anti fungal has been, in my experience, disappointing.