Treating Candida Albicans Intestinal Yeast Overgrowth in Celiac Disease

The frequency of intestinal overgrowth by candida albicans is increased in people with celiac disease. In fact, infection by this common organism, also called C. albicans or candida, appears to be a trigger in the onset of celiac disease.1 Candida is yeast, a budding type of fungus, capable of fermenting carbohydrates. Albicans identifies this particular yeast from many others.

Candida albicans usually maintains a tiny appearance in our intestinal tract unless conditions change to favor its growth. It can thrive and invade if the intestinal lining becomes inflamed or damaged, the composition of normal flora becomes disrupted, immune defenses become diminished or malnutrition reduces our health. Candida albicans infection is characterized by superficial, irregular white patches with a red base. Invasion of the bloodstream is possible and would be life-threatening.

Candida albicans contains amino acid sequences composing a protein called hyphal wall protein 1 (HWP1) that are identical, or similar, to known celiac disease related alpha gliadin and gamma-gliadin T-cell epitopes. Gliadin T-cell epitopes are molecules from wheat gluten that trigger antibody formation in celiac disease. The amino acid sequence in Candida albicans is a transglutaminase substrate like gliadin, and is used by Candida albicans to adhere to the intestinal lining. Furthermore, tissue transglutaminase and endomysium components could become covalently linked to the yeast. Subsequently, Candida albicans might function to stimulate antibody formation against HWP1 and gluten, and form autoreactive antibodies against tissue transglutaminase and endomysium. 1

Why Does Candida Albicans Begin to Thrive?

Inflammation of the intestinal lining, disruption of normal flora, lowered resistance to infection, and malnutrition all contribute favorable conditions for candida infection.

Local inflammation, by damaging protective surface cells, provides an opportunity for disease-producing organisms to adhere to the lining. Think of an infected wound.

Disruption of normal flora, called dysbiosis, by reducing beneficial bacteria colonies and populations, allows space for the yeast colonies to grow. Normally, beneficial bacteria colonies cover the intestinal surface, crowding out disease-producing organisms like yeast. In this way, yeast though present, are kept to a minimum. Studies show, however, that dysbiosis exists in celiacs irrespective of the gluten-free diet so that celiacs are at higher risk for flora loss and/or imbalance. Medical therapies such as antibiotics that kill flora as a side effect may have a more pronounced effect on the flora of celiacs than in non-celiacs.

Lowered resistance to infection, by removing natural defenses, allows yeast to take hold and multiply more freely. Stomach acid is a first line of defense against ingested organisms like yeast. Low acid is common in celiac disease and cannot properly kill yeast to prevent them from passing into the intestine. Lack of appropriate nutrients diminish or disable resistance of the intestinal lining to infection. Low spleen function, also common in celiac disease, may not produce adequate antibodies and white blood cells to fight infection.

Malnutrition, by depriving our cells of nutrients, encourages infection. Proteins are needed for tissue regeneration and repair and for producing enzymes needed to properly digest and metabolize food. Iron, zinc, copper, vitamin C and riboflavin are needed for proper blood cell formation and activity needed to fight infection. Vitamin D, omega-3 fatty acids and selenium also plays a role in immunity, while vitamin A and niacin are needed for the integrity of the intestinal lining itself.
Invasion of the bloodstream by Candida albicans through the intestinal lining is favored by disordered intestinal permeability or leaky gut syndrome, a part of celiac disease.

What Are Symptoms of a Candida Overgrowth?

It is not easy to identify Candida albicans overgrowth in the intestine. Proliferation of candida reportedly causes sugar and starch cravings because carbohydrates are the foods yeast ferment (feeds on). Fermentation causes bloating as the yeast rapidly give off gases. Diarrhea and/or constipation, abdominal pain and possible food intolerances occur. If the yeast invades the bloodstream, fatigue, anxiety, irritability, depression, difficulty concentrating and lethargy develop that can be extreme and life-threatening.

What Is the Treatment?

Specific anti-fungal medication such as nystatin, diflucan, and sporanox is medically prescribed to kill the yeast. Along with the medication, a strict diet with probiotics and prebiotic food is fundamental to restore health quickly.

The gluten-free diet must exclude carbohydrates (sugars and starches) as much as possible while taking the anti-fungal medication. Sugars include jelly, maple syrup, table sugar, honey, molasses, fructose, soda, fruit and fruit juices. Starches include gluten-free flours, bread, bagel, pizza, pasta, bakery products (cookies, cakes, pies, muffins, brownies), cereals, granolas, energy/ breakfast bars, and chips of any kind. This removes the type of food needed by the yeast to thrive. Other exclusions are mushrooms and other fungi, yeast-raised bread, vinegar, cheese and milk products.

So the diet will consist of meat, fish, seafood, poultry, eggs, nuts, fats, seeds and non-starchy vegetables such as lettuce, endive, escarole, kale, asparagus, Jerusalem artichoke, broccoli, cauliflower, Brussels sprouts, cabbage, bok choi, turnip greens, collards, onions, garlic, celery, tomatoes, peppers, fennel, summer squash and cucumbers. These vegetables along with cinnamon, oregano, basil and mint help in the fight against yeast. Lemon and lime juices are OK.

Probiotics foods or supplements with living microbes are needed to restore flora. A study in mice demonstrated that probiotic bacteria can affect the capacity of mice to form antibodies to Candida albicans and showed the usefulness of different probiotic bacteria to produce beneficial health effects in mice.2 Prebiotic foods such as Jerusalem artichokes, asparagus, onion, burdock root, and Chinese chives stimulate the growth of beneficial bacterial species.

Daily vitamin/mineral supplements in normal doses should be taken to provide nutrients for restoring health. Extra zinc and vitamin C during the infection will improve the body’s ability to fight against it.

To sum up, people with celiac disease are always at risk for developing a Candida albicans yeast infection. The best defense is to maintain a strict nutritious gluten-free diet bolstered with probiotic and prebiotic food and a daily 100% vitamin/mineral supplement.

References:

• Cleo Libonati. “Recognizing Celiac Disease.” GFW Publishing, 2007.
• Wagner RD, Dohnalek M, Hilty M, Vazquez-Torres A, Balish E. Effects of probiotic bacteria on humoral immunity to Candida albicans in immunodeficient mice. Rev Iberoam Micol.2000 Jun;17(2):55-9
• Nieuwenhuizen WF, Pieters RHH, Knippels LMJ, Jansen MCJF, Koppelman SJ, “Is Candida albicans a trigger in the onset of coeliac disease?” The Lancet, Volume 361, Issue 9375, 21 June 2003, Pages 2152-2154.Copyright © Cleo Libonati 2007.*Cleo Libonati is president/CEO and co-Founder of Gluten Free Works, Inc. www.glutenfreeworks.com. She is the author of Recognizing Celiac Disease. www.recognizingceliacdisease.com. She can be reached at cleo.libonati@glutenfreeworks.com.