The second facet of the treatment is to diminish the amount of yeast present. This is what Western medicine is so good at accomplishing. Nystatin powder is the most commonly used pharmaceutical for initial treatment of intestinal yeast. Nystatin itself is made from a culture of certain bacteria and it will actually kill yeast. It is not readily absorbed through the intestinal mucosa, so basically it just handles the gastrointestinal yeast. Since it is most often given as pure powder dissolved in water, it will also kill some of the yeast in the oral cavity when it is gargled. A solution can be used to wash the sinuses as well by dissolving nystatin in saline solution and using a dropper or inhaling the solution. For men with candidiasis and recurrent prostatitis or genital or skin symptoms of yeast, or for women with recurrent cystitis or other systemic symptoms, I may prescribe a stronger antifungal agent called ketoconizole, brand name Nizoral. This is effective for most yeast problems, but it can be irritating to the liver, so its use must be watched closely. For people who do not respond well to Nystatin or other natural remedies, Nizoral may be indicated. The usual dosage is one 200 mg. tablet daily for three to six weeks if it is well tolerated. A new Nizoral-related drug, fluconazole, or Diflucan, is now available and, though expensive, may be a slight improvement over Nizoral. Other "azole" drugs are available from many European countries and Canada. These include clotrimazole, miconazole, tinadazole, and econazole. They have similar systemic antifungal action (most are also mild amoebicides), are less expensive, and are also less toxic on the liver.

During yeast treatment, symptoms may arise secondary to killing the yeast. This occurs most with Nystatin, at times with the natural therapies, and only occasionally with the systemic medicines. The symptoms might include headache, fatigue, a mild flulike syndrome, or an exacerbation of already existing symptoms. It may be helpful during "die-off" periods to clear the colon every two or three days with a water enema or have a colonic irrigation every week or two for several treatments. Adding some Nystatin to the water to introduce it directly into the colon may help clear some more yeast.

Natural remedies that help to reduce yeast by killing it or by interfering with its growth include caprylic acid, fresh garlic and garlic extract, and the herb, pau d’arco, or taheebo. Caprylic acid is a natural fatty acid extracted from coconut oil. It interferes with the growing and duplicating process of the Candida albicans does not actually kill yeast, but it is effective in reducing intestinal yeast levels. It must be used for a fairly long period. I often prescribe the caprylates to follow a two to three month course of Nystatin and use a caprylic acid product such as Caprystatin or Capricin for a few months also. The length of treatment for yeast depends on the degree of the problem, the response to the treatment, and the results of tests.

Garlic has been shown to kill some yeast in sensitivity tests in the lab. It can be added to the treatment regimen and often helps. Two capsules several times daily is the usual dosage, though good garlic may have a blood-pressure-lowering effect at that amount, which may detrimentally affect some people. Goldenseal root also has some antifungal properties. Pau d’arco, a Brazilian tree bark, has become a very popular herb in the treatment of yeast, allergies, and other immune problems. It can be taken in capsules, or tea made from the bark can be drunk several times daily. It seems to tonify or strengthen the gastrointestinal tract and may help reduce yeast.