Fungal Overgrowth Blues: are you really hosting fungal overgrowth? Here is what you should know.

Fungal overgrowth is a common diagnosis, but often, the problem is more complex. Take the approach of Functional Medicine Australia.

The human gastrointestinal tract or gut is home to trillions of microorganisms, collectively known as the gut microbiota. These microbial inhabitants include hundreds of species of bacteria, fungi, viruses, archaea and protozoa¹. In healthy people, these diverse microbial communities thrive in perfect equilibrium, with bacteria representing the most abundant group. However, when this equilibrium is broken, alterations to your optimal gut function can occur, including gut dysbiosis and Small Intestinal Bacterial Overgrowth (SIBO), which can lead to multiple health problems. Functional Medicine Australia takes a new approach to health, considering your health as well as the health of your gut microbes, based on comprehensive advanced testing.

Gut Dysbiosis

Alterations to the normal composition and diversity of gut microbes can result in gut dysbiosis, where specific microbial species are depleted, whereas others are over-represented. Another related condition is SIBO where the overgrowth occurs in the small intestine.

Gut dysbiosis and SIBO have been linked to multiple health problems, including dysregulation of the immune system, causing abnormal inflammatory responses. Such inflammatory alterations can contribute to the development of chronic inflammatory conditions, like inflammatory bowel disease, multiple sclerosis, allergic asthma, and rheumatoid arthritis^2-6. Conditions like cystic fibrosis and fungal overgrowth are also associated with gut dysbiosis^6-7.

Gut dysbiosis and SIBO occur when there is an overgrowth of normally harmless microbes, which can lead to disease or can facilitate infection by external pathogens, like fungi. Learn more about the gut microbiome and your health here. Functional Medicine Australia takes a modern approach to your health, taking into account the health of your gut mycobiome, among many other factors.

Focus on: the human mycobiome

The human mycobiome is the name given to the community of fungal species inhabiting our skin, mouth, and inner organs. Fungi are an ancient group of organisms that include the well-known mushrooms, but also yeasts (like those used to make beer or bread) and moulds (like those that grow on old bread). Fungi are found everywhere in nature, as free-living organisms but also as parasitic or infectious agents, living on or inside plants or animals, including humans.

In humans, more than a hundred different species of fungi have been reported to live in different parts of the body (Figure 2).

There is also a rich diversity of fungi among different people. For example, one study that compared the oral fungal diversity among 20 healthy persons identified 101 fungal species among all participants¹⁰. However, each person only hosted between 9-23 fungal species in their mouth, showing that there is a large diversity of fungi among humans. Another study, which generated data for 317 stool samples from the Human Microbiome Project, found that the human gut is dominated by yeast belonging to the Saccharomyces, Malassezia, and Candida genera¹⁵.

These fungal species live alongside our gut, skin and oral bacteria, as well as alongside all the other microorganisms that constitute our body’s microbiota. In health, all these microbial groups live in balance and harmony, with bacteria representing the dominating group, limiting the growth of other groups. However, when gut dysbiosis occurs, this balance is broken and overgrowth by potentially pathogenic fungal species can occur. In fact, fungal overgrowth and fungal infections are common conditions that are associated with a wide range of conditions, including digestive problems, changes in mood, headaches, skin problems, immune malfunction, fatigue and weight gain, among other health problems⁶.

Fungal overgrowth and infections in Australia

One of the most common fungal infections affecting Australians involves yeast infections by the genus Candida. Candidais a fungus commonly found as part of the normal, healthy microbiota of the mouth, gut and genitals, in both males and females. But, under certain circumstances, Candida yeast overgrowth can lead to a disease called candidiasis. Some fungal Candida-related infections, like vaginal thrush, affects as many as 75% of all Australian women.

What is Candidiasis?

Candidiasis is a common yeast infection caused by an overgrowth of the yeast Candida. It is not a sexually transmitted disease, as it is exclusively caused by fungal overgrowth. While Candida is a common inhabitant of your oral cavity, gut and genitals if it overgrows it can cause health problems. The most common species causing candidiasis in adults is Candida albicans, whereas Candida parapsilosis is a species that mostly affects babies and transplant patients. Although less common, Candida parapsilosis is another species known to affect adults^8-9.

• Typical symptoms – depending on the site where the Candida outgrow occurs, people suffering from candidiasis can experience multiple symptoms. For example,

• • Genital candidiasis – also known as genital thrush, can cause redness and swelling of the vagina, a burning, itching or stinging sensation, pain during sex or urination, and is typically accompanied by vaginal discharge with a strong “yeasty” smell. This condition can also affect males, causing similar symptoms as in women. Male genital thrush causes soreness and redness in the penis head, smelly discharges and pain when urinating.

• • Oral candidiasis – also known as oral thrush, this condition is characterised by taste loss, pain while eating or swallowing, and white patches and soreness in the inside of the mouth. Oral candidiasis is not limited to the mouth, it can also extend to the throat and oesophagus. Candidiasis of the oesophagus is a common condition in people living with HIV/AIDS or with a compromised immune system. Typical symptoms include pain/difficulty swallowing, nausea, vomiting, chest pain and weight loss.

• • Candidiasis in the gut – various factors can lead to the overgrowth of gut fungal species such as Candida, which can potentially affect various aspects of your health. For example, overgrowth of Candida in the gut is associated with multiple diseases of the gut, like ulcerative colitis, Crohn’s disease, gastric ulcers and reduced inflammatory responses¹⁶. Typical symptoms depend on the specific disease but may include bloody diarrhea, abdominal pain and cramping, weight loss, fatigue, fever, reduced appetite, or vomiting.

• • Invasive candidiasis – this serious condition occurs when the Candida species manages to invade the bloodstream, infecting organs like the kidney, heart bones, eyes, and even the brain. This condition is more common in hospitalised patients or in people who are already suffering from other conditions. Typical symptoms vary, depending on the site of infection and may include dysphagia, skin or mucosal lesions, blindness, vaginal symptoms (itching, burning, discharge), fever, shock, oliguria, renal shutdown, and others.

• Factors triggering Candida overgrowth – Several factors are known to influence the overgrowth of Candida. Below we discuss some of the most important factors.

• • Antibiotic use – long-term antibiotic use drastically changes the composition of gut microbiota in mice, favouring the presence of fungal species^17-18

• • Certain conditions can favour the development of candidiasis, like being pregnant or suffering from certain diseases, like diabetes or a compromised immune system^19-23

• • Hormonal contraceptives have been associated with Candida outgrowth²⁴.

• • Early-life factors – anything from your mode of delivery (C-section vs natural birth) to the lifestyle of your mother and your early feeding habits (e.g. being breastfed) can influence your chances of developing fungal overgrowth^25-26.

• • Immune dysfunction, which can be caused by genetic malfunctions or exposure to environmental toxins, among other factors²⁷.

• • Unhealthy eating habits – following a diet rich in carbohydrates and sugar, for example, can favour yeast growth²⁸.

• • Chronic stress – studies have shown that chronic stress is among the factors that can predispose women to develop vaginal candidiasis²⁹.

• • Use if certain medicines, like corticosteroids, oral contraceptives or certain prescription drugs^30-31

Do you suffer from fungal overgrowth?

Today, a significant proportion of patients in primary care are misdiagnosed with fungal overgrowth and prescribed a treatment plan that can worsen their condition. This is a problem because often patients may be suffering from other health problems, like SIBO, in addition to fungal overgrowth or might not even have fungal overgrowth at all.

Fungal overgrowth testing is crucial

Accurate and comprehensive testing is critical to confirm fungal overgrowth and to rule out any other potential health problems. Only after the results of comprehensive testing have been analysed, a treatment plan can be envisioned.

Our model of Modern functional medicine Australia relies on comprehensive testing and interpretation before any treatment plan is developed.

Our approach of Modern Functional Medicine Australia employs the following testing:

• Advanced stool analysis
  here we employ a complete microbiome mapping approach, called GI-MAP, which currently stands as the most advanced DNA-based stool test available in Australia. This comprehensive test can identify the microbial diversity of your gut and identify if you have any worrisome levels of pathogens, including yeast and other microbes that can cause disease. This test will also measure the levels of multiple health markers, like specific enzymes, fat and blood content in stool, and confirm the presence of genes involved with antibiotic resistance. Read more about our testing here.

• Organic Acid Testing
  this is a urine test that can detect a wide range of important biological markers of health. These markers can inform us about how well your metabolism is working and how well cells are functioning. It can also inform us about your levels of vitamins and other important chemicals, like neurotransmitters or about the presence of toxins. Learn more about our Organic Acid Testing here.

• Immunological testing
  this test allows for the identification of biological markers that can inform us about the presence of Candida yeast infection in the blood. This would be indicative of a serious systemic yeast infection.

Modern Functional Medicine Australia: a better approach to fungal overgrowth

At the Australian Centre for Functional Medicine, we take a comprehensive approach for testing and treating fungal infections. We take into consideration your current symptoms and consider the possibility of fungal overgrowth, but we are mindful about the wide range of other possible conditions that can affect you.

We rely on our extensive testing panels, which analyse your blood, stool, urine, and breath and provide critical information about every aspect of your body function and health status. Once we have analysed your test results, we can develop a treatment plan, which can include different approaches, from standard care treatments (antibiotics, or other drugs) to natural and preventive approaches.

For all patients, a new nutritional plan is designed based on their personal needs and requirements. Following the design of a nutritional plan, we follow a two-phase approach; First, removal of the pathogen, in case of infection, or clearing the fungal overgrowth. Once your body is clear from the infection or overgrowth, we can start the second phase, focused on rebuilding and restoring your gut microbiome and nutrient status.

If you suspect a yeast infection is affecting your health, become a patient today and learn about all the factors that might be at play.

References

1. Gilbert JA, Blaser MJ, Caporaso JG, Jansson JK, Lynch SV, Knight R. Current understanding of the human microbiome. Nature medicine. 2018 Apr;24(4):392. Read it!
2. Miyake S, Kim S, Suda W, Oshima K, Nakamura M, Matsuoka T, Chihara N, Tomita A, Sato W, Kim SW, Morita H. Dysbiosis in the gut microbiota of patients with multiple sclerosis, with a striking depletion of species belonging to clostridia XIVa and IV clusters. PloS one. 2015 Sep 14;10(9):e0137429. Read it!
3. Rivas MN, Crother TR, Arditi M. The microbiome in asthma. Current opinion in pediatrics. 2016 Dec;28(6):764. Read it!
4. Ott SJ, Kühbacher T, Musfeldt M, Rosenstiel P, Hellmig S, Rehman A, Drews O, Weichert W, Timmis KN, Schreiber S. Fungi and inflammatory bowel diseases: alterations of composition and diversity. Scandinavian journal of gastroenterology. 2008 Jan 1;43(7):831-41. Read it!
5. Underhill DM, Iliev ID. The mycobiota: interactions between commensal fungi and the host immune system. Nature Reviews Immunology. 2014 Jun;14(6):405. Read it!
6. Cui L, Morris A, Ghedin E. The human mycobiome in health and disease. Genome medicine. 2013 Jul;5(7):63. Read it!
7. Kramer R, Sauer-Heilborn A, Welte T, Guzman CA, Abraham WR, Höfle MG. Cohort study of airway mycobiome in adult cystic fibrosis patients: differences in community structure between fungi and bacteria reveal predominance of transient fungal elements. Journal of clinical microbiology. 2015 Sep 1;53(9):2900-7. Read it!
8. Trofa D, Gácser A, Nosanchuk JD. Candida parapsilosis, an emerging fungal pathogen. Clinical microbiology reviews. 2008 Oct 1;21(4):606-25. Read it!
9. Krcmery V, Barnes AJ. Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance. Journal of Hospital Infection. 2002 Apr 1;50(4):243-60. Read it!
10. Ghannoum MA, Jurevic RJ, Mukherjee PK, Cui F, Sikaroodi M, Naqvi A, Gillevet PM. Characterization of the oral fungal microbiome (mycobiome) in healthy individuals. PLoS pathogens. 2010 Jan 8;6(1):e1000713. Read it!
11. Findley K, Oh J, Yang J, Conlan S, Deming C, Meyer JA, Schoenfeld D, Nomicos E, Park M, Kong HH, Segre JA. Human skin fungal diversity. Nature. 2013 Jun 20;498(7454):367. For the Nare, glabella, elbow pit and palms, this study found that most of the skin in these areas is covered by multiple species of the fungal genus Malassezia, about 11 species across all sites. The study also identified small proportion of other fungal groups, including multiple species of the genus Candida and Cryptococus. Read it!
12. Underhill DM, Iliev ID. The mycobiota: interactions between commensal fungi and the host immune system. Nature Reviews Immunology. 2014 Jun;14(6):405. Healthy lungs are currently thought not to host any inherent mycobiota. Instead, it is temporarily inhabited by oral and environmental fungi. Read it!
13. Drell T, Lillsaar T, Tummeleht L, Simm J, Aaspõllu A, Väin E, Saarma I, Salumets A, Donders GG, Metsis M. Characterization of the vaginal micro-and mycobiome in asymptomatic reproductive-age Estonian women. PloS one. 2013 Jan 23;8(1):e54379. As presented in Table 2. Read it!
14. Hallen-Adams HE, Suhr MJ. Fungi in the healthy human gastrointestinal tract. Virulence. 2017 Apr 3;8(3):352-8. Multiple studies have identified a total of 267 different fungal species inhabiting the gut. However, only 15 have been confirmed as most likely to be normal inhabitants of the GIT. The others come and go, influenced by diet, medication, and other environmental factors. Read it!
15. Nash AK, Auchtung TA, Wong MC, Smith DP, Gesell JR, Ross MC, Stewart CJ, Metcalf GA, Muzny DM, Gibbs RA, Ajami NJ. The gut mycobiome of the Human Microbiome Project healthy cohort. Microbiome. 2017 Dec;5(1):1-3. Read it!
16. Kumamoto CA. Inflammation and gastrointestinal Candida colonization. Current opinion in microbiology. 2011 Aug 1;14(4):386-91. Read it!
17. Dollive S, Chen YY, Grunberg S, Bittinger K, Hoffmann C, Vandivier L, Cuff C, Lewis JD, Wu GD, Bushman FD. Fungi of the murine gut: episodic variation and proliferation during antibiotic treatment. PloS one. 2013 Aug 19;8(8):e71806. Read it!
18. Noverr MC, Noggle RM, Toews GB, Huffnagle GB. Role of antibiotics and fungal microbiota in driving pulmonary allergic responses. Infection and immunity. 2004 Sep 1;72(9):4996-5003. Read it!
19. Sopian IL, Sa’adiah Shahabudin MA, Lung LT, Sandai D. Yeast infection and diabetes mellitus among pregnant mother in Malaysia. The Malaysian journal of medical sciences: MJMS. 2016 Jan;23(1):27. Read it!
20. Espern A, Morio F, Miegeville M, Illa H, Abdoulaye M, Meyssonnier V, Adehossi E, Lejeune A, Cam PD, Besse B, Gay-Andrieu F. Molecular study of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon intestinalis among human immunodeficiency virus-infected patients from two geographical areas: Niamey, Niger, and Hanoi, Vietnam. Journal of clinical microbiology. 2007 Sep 1;45(9):2999-3002. Read it!
21. Hallen-Adams HE, Suhr MJ. Fungi in the healthy human gastrointestinal tract. Virulence. 2017 Apr 3;8(3):352-8. Read it!
22. Anaissie E, Bodey GP, Kantarjian H, Ro J, Vartivarian SE, Hopfer R, Hoy J, Rolston K. New spectrum of fungal infections in patients with cancer. Reviews of infectious diseases. 1989 May 1;11(3):369-78. Read it!
23. Heinic GS, Greenspan D, MacPhail LA, Greenspan JS. Oral Geotrichum candidum infection associated with HIV infection: a case report. Oral surgery, oral medicine, oral pathology. 1992 Jun 1;73(6):726-8. Read it
24. Donders G, Bellen G, Janssens D, Van Bulck B, Hinoul P, Verguts J. Influence of contraceptive choice on vaginal bacterial and fungal microflora. European Journal of Clinical Microbiology & Infectious Diseases. 2017 Jan 1;36(1):43-8. Read it!
25. Dinleyici M, Pérez-Brocal V, Arslanoglu S, Aydemir O, Ozumut SS, Tekin N, Vandenplas Y, Moya A, Dinleyici EC. Human milk mycobiota composition: relationship with gestational age, delivery mode, and birth weight. Beneficial Microbes. 2020 Mar 27;11(2):151-62. Read it!
26. Azevedo MJ, de Lurdes Pereira M, Araujo R, Ramalho C, Zaura E, Sampaio-Maia B. Influence of delivery and feeding mode in oral fungi colonization–a systematic review. Microbial Cell. 2020 Feb 3;7(2):36. Read it!
27. Verma A, Gaffen SL, Swidergall M. Innate immunity to mucosal Candida infections. Journal of Fungi. 2017 Dec;3(4):60. Read it!
28. Gunsalus KT, Tornberg-Belanger SN, Matthan NR, Lichtenstein AH, Kumamoto CA. Manipulation of host diet to reduce gastrointestinal colonization by the opportunistic pathogen Candida albicans. MSphere. 2016 Feb 25;1(1). Read it!
29. Akimoto-Gunther L, Bonfim-Mendonça PD, Takahachi G, Irie MM, Miyamoto S, Consolaro ME, Svidzinsk TI. Highlights regarding host predisposing factors to recurrent vulvovaginal candidiasis: chronic stress and reduced antioxidant capacity. PloS one. 2016 Jul 14;11(7):e0158870. Read it!
30. Fukushima C, Matsuse H, Tomari S, Obase Y, Miyazaki Y, Shimoda T, Kohno S. Oral candidiasis associated with inhaled corticosteroid use: comparison of fluticasone and beclomethasone. Annals of Allergy, Asthma & Immunology. 2003 Jun 1;90(6):646-51. Read it!
31. Grigoriou O, Baka S, Makrakis E, Hassiakos D, Kapparos G, Kouskouni E. Prevalence of clinical vaginal candidiasis in a university hospital and possible risk factors. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2006 May 1;126(1):121-5. Read it!