Candidiasis: Management Through Probiotics

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Candida yeast is a normal inhabitant of our skin,  gastrointestinal tract, and mucous membranes, including the vagina, mouth, and nasal passages. These eukaryotes naturally live in the vagina but they are only problematic when the bacterial balance is exasperated.  Potential Candida overgrowth can be associated with a history of high sugar/fruit consumption; severe stress; pregnancy, compromised immune system, taking antibiotic/steroid/birth control medication or even prolonged exposure to mold-ridden environments. Antimicrobial abuse is the major cause of Candidiasis.

C. albicans, cause vulvovaginal candidiasis (VVC), in 50% of females of reproductive age and it can also affect the penis, resulting in itching, inflammation and urinary and sexual discomfort. Yeast infections ordinarily don't cause any recognizable vaginal odors, which distinguishes them from other vaginal infections. If there's an odor, it's usually rather moderate and yeasty. Excess of body weight exaggerates Candidiasis due to creation of skin folds and along with tight clothing create  ideal sweaty and moist conditions for Candida overgrowth. Being obese makes it difficult to regulate blood glucose, and poorly managed blood sugar helps to feed Candida growth. The broader range of Candida-related symptoms can include thrush (vaginal or oral), diarrhea/constipation, bloating, belching, rectal itching, food intolerances, and a propensity towards stomach upsets, acne/eczema, chronic fatigue syndrome, headaches, mental disorders such as anxiety, confusion and 'foggy brain'. Another harmful side effect of Candida overgrowth can be intestinal permeability as the yeasts burrow into and compromise the delicate intestinal mucosa enter the bloodstream and become systemic, affecting body organs beyond the digestive system. The mycotoxins that the yeasts excrete cross the blood-brain barrier and the mental symptoms such as confusion (often described as 'foggy brain') and anxiety can develop.  Symptoms of this can manifest as generalized inflammation, skin rashes, and other allergic symptoms.  

Management of candidiasis  using different approaches

It is a challenge to manage and overcome candida. Conventional treatments include antifungals such as Clotrimazole, nystatin, which can be used topically. Fluconazole is used as an oral medication while clotrimazole is used in form of suppositories for vaginal yeast overgrowth which can initially help symptoms, but Candida is a survivor and can retreat deep into body tissues when faced with antifungals, lying dormant there until conditions for its survival improve. This is why a combination of prescription or natural antifungals, appropriate dietary interventions including supplements, and effective probiotics is prescribed to finally put this pathogen back in its place. 

Diet management

Managing the diet by reducing intake of yeast supporting foods to keep the yeast 'living', in a less powerful form, rather to be displaced and eliminated. The  low glycemic protein sources such as beans and lentils should be preferred because of high fiber content, which not only acts as a prebiotic to feed beneficial bacteria, it also helps keep blood glucose in check to help thwart yeast infections. Anti-Candida diets typically exclude processed, high-sugar foods, some fruits, and 'yeasty' foods and drinks like bread and alcohol which are all thought to promote the growth of this pathogen, and any foods to which the patient may have become intolerant. A gut-healing, immunity-supporting diet is desirable, along with foods that can help to naturally suppress Candida and promote the growth of beneficial bacteria - coconut oil contains caprylic acid so can be a useful addition, like olive oil, garlic, onions, and ginger for their anti-fungal and prebiotic potential. 

Probiotic strains used to prevent candida infection

Beneficial bacteria can also help to displace Candida populations; Probiotics can help with leaky gut caused by Candida by re-enforcing the lining of the gut. This also helps to prevent gaps from forming in the space between the enterocytes which leads to increased intestinal permeability. the antimicrobial effect of probiotic bacteria is strain-specific; hence, the selection of probiotics for therapeutic purposes should be targeted for specific pathogens and their beneficial effects cannot be generalized. L. paracasei 28.4, L. rhamnosus 5.2, and L. fermentum 20.4 isolates showed the greatest antifungal activity, helping to prevent the formation of Candida biofilm. Lactobacillus rhamnosus GG/LS, L. rhamnosus GR-1, L. rhamnosus HS111, L. Rhamnosus 5.2, L. acidophilus LA02, L. acidophilus ATC 4356, L. acidophilus HS101, L. Lactis, L. Helveticus, L. casei GG, L. Paracasei 28.4, L. Plantarum, L. plantarum CMPG5300, L. reuteri RC-14, L. fermentum LF10, L. Fermentum 20.4, Bifidobacterium breve, B. Bifidum, B. Animalis  and B. animalis subs. Lactis, Saccharomyces cerevisae is used as probiotics against candida infection.

Intravaginal probiotic strains to enhance the efficacy of management of candiasis

The regular intravaginal administration of live S. cerevisiae (CNCM I-3856 strain) and, to a lesser extent, of inactivated S. cerevisiae (CNCM 1-3856 strain), evoked C. albicans clearance at levels similar to those obtained with fluconazole. The beneficial effect of both live and inactivated S. cerevisiae was due to a co-aggregation of Candida and consequently it is unable to adhere to the mucosal surface, protecting the vaginal epithelium from the fungus induced damage only the live and not the attenuated yeast strongly suppressed some of the crucial virulence factors of C. albicans, such as its capacity to switch from the yeast to the hyphal form due to to the ability of the live yeast to significantly inhibit the expression of two important hyphal growth-associated genes, in particular the hyphal wall protein 1 (HWP1) and extent of cell elongation 1 (ECE1) and the ability to express aspartyl proteases (SAPs), SAP2, and SAP6, which play a key role in the immunopathogenesis of vaginal candidiasis. Saccharomyces boulardii,  has displayed anti-Candida properties has been shown to inhibit populations of Candida and deter them from establishing in the intestines and it's  translocation from the digestive tract. because S.boulardii produces caprylic acid, an antifungal substance that is effective against Candida yeasts thus reducing the potential for Candida infestation and inflammation in inflammatory bowel disease.

Nanoparticle assisted management of candidiasis

Beneficial bacteria can also help to displace Candida populations; e.g. strains of Lactobaccilli, Lactobacillus acidophilus NCFM®, have been shown in studies to stimulate the production of antibodies to C. albicans antigens. Sometimes the efficacy against Candida. Is increased by supplementing the medium with chemical adjuvants, such as selenium. Which is an essential micromineral that regulates metabolism and is known to reinforce immunity. Selenium nanoparticle-enriched Lactobacillus plantarum and Lactobacillus johnsonii cells and supernatant have shown higher antifungal activity against C. albicans than controls devoid of the nanoparticles that several bacteria can interfere with the biofilm growth by reducing hyphal development a result akin to that described above. The  probiotic cell-free supernatant had a strong and significant inhibitory effect on biofilm development on denture acrylic strips than the bacteria per se, the inhibitory agent is an exometabolite secreted into the medium. Streptococcus salivarius K12 was not directly fungicidal but appeared to inhibit Candida adhesion to the substratum and increase the planktonic cells in the culture medium. Despite such in vitro data on the inhibitory effect of probiotic products on yeasts, the direct effect of probiotics on mucosal candidiasis is yet to be shown in a laboratory environment mimicking the oral cavity, vagina, or GI tract.

Host factors

The host response to probiotics is likely to play an important role in probiotic-mediated microbiome effects. The modulation of both innate and adaptive immune systems is probably associated with alteration of the cytokine profile and Candida recognition by epithelial and immune defense cells. Evidence to imply probiotic interference with these host defense factors during candidal infestation is still needed.

How to use probiotics as home remedy

Probiotics come in several forms that you can use in different ways: in the form of capsules or suppositories, which can be inserted in vagina. When choosing a capsule or suppository, look for one that includes a list of the bacteria it contains. For a more cost-effective option, yogurt can be used. Just make sure you choose one with a label that mentions live cultures and Lactobacillus. Avoid yogurts with added sugar or flavoring. Yeast feeds on sugars, so plain yogurt is best for a yeast infection. To use the yogurt, remove a cotton tampon from its applicator and refill the applicator with yogurt. Lay down while inserting the applicator and releasing all of the yogurt into your vagina. Wait a few minutes before standing up to give it time to settle in.

As with other creams for yeast infections, the yogurt will eventually start leaking out of your vagina. Applying it right before bed or when you won't be standing for long periods. You can also apply yogurt to your vulva, which is the outer part of your vagina, to relieve itching and burning. The use of yogurt and honey in the vagina suggests that this mixture takes about a week to work. Oral probiotics, on the other hand, can take anywhere from one to four weeks to alter the microbiota of your vagina. If you choose to use oral probiotics, you can still apply yogurt to your vulva to help manage your symptoms while you wait for them to work. 

CONCLUSION

Patients must understand that any anti-Candida protocol is not a permanent fix that will prevent this troublesome yeast from causing future health issues. The major attribute of probiotics appears to be the restoration of a natural healthy microbiome in a given habitat, turning it from a catastrophic, disease-inducing, dysbiotic microbiota to a healthy, symbiotic, stable equilibrium. Several hypotheses, most unproven as yet, have been proposed for the genesis of this well-balanced state from disease to health. Probiotics may compete for nutrients and receptors on the cell surfaces with the pathogenic microorganisms, thus preventing their adhesion and colonization on the mucosal surfaces. Co- and auto-aggregation of probiotics with the formation of a critical mass required for healthy biofilm development may act as a protective lining against pathogenic infection  Apart from the above, the production of biosurfactants that interfere with microbial adhesion and desorption the release of exo metabolites such as lactic, acetic, and capric acid, and the production of bacteriocins and hydrogen peroxide (H2O2) are other possible attributes postulated as mechanisms for probiotic activity.  Maintaining a healthy diet and lifestyle is essential, but as our intestinal flora form a key part of our immune system defenses against this pathogen, it's also very important to maintain a healthy gut microbiota as our intestinal environment is constantly evolving.

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