Fungus Among Us: Diagnosing And Treating Yeast Problems with Dr. George Papanicolaou

Coming up on this episode of the Doctor's Pharmacy.

It's usually gut dysbiosis or imbalances of bacteria to begin with. It's the fact that the nutrition's been really poor and they have multiple nutritional deficiencies. They live that really stressed out life. And that stress changes the gut microflora in such a way it makes you more susceptible to Candida.

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Welcome to the Doctor's Pharmacy.

I'm Dr. Mark Hyman, and that's Pharmacist on F-A-R-M-A-C-Y, a place for conversations that matter. And if you've ever heard of yeast issues or candida, or you think you might have some weird bloating after you eat, or something weird going on with you related to yeast or fungus, or maybe you have athlete's foot or vaginal itching or anal itching, this is the podcast for you because we're going to talk about what this is all about, what's true, what's not true, how to deal with it, and why it's such a problem with none other than my friend and colleague at the Ultra Wellness Center, Dr. George Papachroniakos, who's a rock star in his own right and has been just such a great contribution to the center here and has the second most popular podcast of all my podcasts, which is pretty awesome. I love that.

I love that too.

He'd beat out everybody. And he's just a great guy, and I think we've been really digging into some great issues here on the House Call version of the Doctor's Pharmacy, which is a special episode dedicated to looking at some of the intractable conditions that people suffer from and they're not getting answers about with traditional medicine. So we're gonna talk today about all things yeast and fungus.

So welcome, George.

Glad to be here, Mark. Okay, so what is the deal with fungus and yeast? You know, we've been hearing for years about Canada and I gotta go on.

The Canada diet and all this stuff.

Is this true or what's the deal?

What's the deal? So Canada is, first off, it is a yeast, which is a type of mold. Okay? It just happens to be the most common yeast to cause infection in humans.

Yeah, like women get Candida infections of their vaginal tract, which is the most common thing.

Yeah, yeah. And, you know, we have other fungi that cause athletes' feet and, you know, other types of skin infections.

It's just like bacteria. There's lots of different fungi. There's not just like one thing like Candida.

Yeah. And Canada is a normal part of our gastrointestinal tract. And so it's not some foreigner, it lives naturally in our gastrointestinal tract. So that's a really fundamental thing to know. And it's part of the balanced ecosystem. Yeah. So, you know, as we talk, we're gonna talk eventually about like, well, when it overgrows, we gotta kill it, right? Well, you need to rebalance it. You know, you don't wanna completely destroy it because it is a part of the ecosystem. so it's a normal part of our ecosystem and it can be problematic. And in conventional medicine, it's very well accepted and understood in immunocompromised patients. 90,000 Americans per year have what we call candidiasis or systemic candida, meaning they have a blood infection because they're immunocompromised. They have AIDS, or if you're on.

Immunosuppressive drugs, or you're on chemo drugs.

Exactly.

Or you've taken steroids. Or if you're diabetic, right, you tend to get more yeast issues.

Yes, you do.

Sugar is high 'cause the sugar is high.

And so in those cases, in those cases, it's very well accepted. Where it becomes a problem is when people begin to, particularly practitioners, begin to listen to somebody's symptoms. I have a headache. I have brain fog. I have fatigue. I have thrush in my tongue. I have body aches. I have menstrual irregularity. I have itchy anus. I have joint pain and I can't sleep. And my libido is low.

Right?

Oh, it must be Candida. Right? No, no. And so they might be. It might be. But now that person, you know, will go spit into a cup and if you see strings, then it's Candida, right? no, those are very nonspecific symptoms and that's not a very good test. But people who are desperate, who are really sick and are looking for answers, will gravitate and will do that. And sometimes it works, but we need to be really careful to know that they may be dealing with a totally different organism. It might be another yeast or another mold. Right, that needs to be treated a different way.

Yeah.

And so that's one thing. It could be, you know, you have general dysbiosis, you may have something- It's.

Imbalance in your gut flora.

Which is imbalance in the gut flora. You may have something called SIBO, which is, you know, bacteria growing where it shouldn't.

It should be- It should be in the small intestine.

Up in the small intestine. And that needs to be treated differently. So we need to be really careful when we talk about Candida, we just talk about yeast and mold as the cause of everything.

It's not the cause of everything, but it's the cause of many and I.

Think it's important to understand that because, you know, because we want, you know, all doctors should understand the importance of certain maladies. And we don't want to throw the baby out with the bathwater. Candida does exist. It can make people sick, but you have to understand how, when and where. Yes. And have appropriate ways to evaluate and test.

That's right. In functional medicine, it's what we focus on. It's how do we get to the root cause or causes. And in some patients, it might indeed be candida. In other patients, it might be other fungus. In other patients, the same symptoms might be caused by something entirely different. So let's talk about what are the common reasons we see fungal problems in our patients? Because they are really common. What are the common reasons we see this.

Yeah, you know, I'd say the biggest issue in our, in our world today is our nutrition. We have a huge amount of sugar, high fructose corn syrup, processed carbohydrates, starch, flour, right. All of that, right? We have GMO, which alters the gut microbiome. All of these things cause an enormous shift. It shifts the bacterial balance. So now organisms that are commensal, meaning that they live. They live in our gut.

They're normally there, but they tend to like bloom if you feed them what they like to eat, right?

Yeah, they bloom. And once you start feeding them and you, they bloom and you have E. Coli is normal part of your gut. But if you shift the ecology of your gut, you're gonna get an enormous overgrowth of E. Coli or Clostridium or Klebsiella. And now all of you have probably heard that you've had an infection and I'm sure you've heard the term E. Coli, I'm sure you've heard Clostridium or Klebsiella which the c difficile, the diarrheal illness. Guess what? They all live in our gut. And when our diet is really poor, they bloom.

And the thing about sugar and flour, which is 60% of our diet is essentially refined carbohydrates, right? That stuff is jet fuel for the yeast in your gut and for the fungus. So you're fertilizing all that stuff and you're starving the good guys which feed on what? they feed on phytochemicals like colorful fruits and vegetables and fiber and all the good stuff. So you're starving the good guys, you're feeding the bad guys, and that's when you start to get this imbalance or overgrowth. There's actually a term for it now called SIFO, or Small Intestinal Fungal Overgrowth, right? But it can cause a lot of systemic symptoms. So how would you know that people might be at risk for it, and how would you look for the symptoms that give you clue that they might have a fungal issue?

It's, you know, I look at Canada as a sort of comes along for the ride, right? And sometimes it's gonna be, it's gonna hijack the ship and become the main player. And sometimes it's gonna be lurking there in the background and you're not gonna realize it's creating a problem till you fix some other things, or you can't fix those other things. so I suspect that most all the time I'm dealing with gut issues.

Yeah.

The kind of gut issues that we see when people come in with long standing constipation, long standing eczema, long standing yeast infections, recurrent, you know, vaginal yeast infections, recurrent UTIs, athlete's foot that's recurrent, allergy, you know, as I said, allergies, I, I start to suspect there's inflammation going on, and then we know there's inflammation. We know we're going to find something in the gut. And can't, you know, Candida needs to.

Be on that list. Yeah. You know, and I, and I, and I think, you know, I go through, like, when I think about it, I go through, what, what are their risks? Right. Have they been on antibiotics that will cause fungal issues? Have they been on hormones like the birth control pill?

Have they taken steroid drugs?

Right. Have they eaten a diet that's Tons of sugar.

Those are the four big players.

Yeah, sugar and starch. Are they drinking a lot of wine and alcohol and beer? These are all things which promote the growth of the fungus. It's like feeding the bad guys. And then, so if they're at risk for that, then I go, wait a minute, what are their symptoms? And like you mentioned, a lot of them, but they can be really common things that people just kind of think, oh, it's not a big deal. I got a fungal toe growth or I have an athlete's foot or I have vaginal itching and yeast issues. I have anal itching. I might have some eczema, I might have some psoriasis, I might have dandruff on my head.

I crave carbohydrates. I crave carbohydrates.

I can't lose weight. I can't lose weight. I'm constipated, like you said. To begin to sort of create this whole thing. And I remember I had this one patient, she was like a walking mushroom. She had like dandruff and eczema and anal itching and vaginal itching, and she had athlete's foot. I mean, she pretty much had everything. And she had these like tinea patches, which is another kind of skin which is a well-known fungal infection called tinea versicolor, which is common. And so she had all these issues and she was also feeling like crap. And people can get other issues from it. They can get depression, they can get fatigue, they can get brain fog, they can get inflammation, they can get joint issues, they can get all these weird symptoms. So I'm always on the alert. And that's not to say that everybody who comes in has a fungal issue with these issues, but you have to make sure you don't overlook it. And that's really what we focus on in functional medicine.

Yeah, yeah. And so when somebody comes in that sick, and that's how we see them, they do come in that sick, and they come in almost despairing sometimes because they've been fighting these symptoms for years and they're being treated with antihistamines and they're being given topical steroids for their rash and they're given PPIs for their.

Heart and their- Acid blockers, right?

Acid blockers for their heartburn or the regurgitation, and they're taking, some over-the-counter Senna for their constipation. So they come in with these long lists of pills to combat every symptom that was put in its own silo. And nobody stopped to put together the fact that maybe these all belong together as one problem.

So we see this a lot and we treat it usually in the context of everything else. It's not only often just the yeast, but it's their overall gut flora and their imbalances. But you had a patient, Julia, who had all these issues and she had a big yeast issue. Tell us about her and what you found and what you did and how you helped her.

Yeah, so Julia, she represents the symptoms that I was just talking about. She came in with fatigue, brain fog, recurrent vaginal yeast infections, anxiety, carb craving, inability to lose weight. She, let me make sure I got it all. Oh, she had migraines as well. She was also under an enormous amount of stress. And I think it's important, and we're gonna talk about that in the role stress plays with Candida, but she had enormous amount of stress, which I came to find out came from some childhood trauma that was significant. Her recent stress was a divorce that had just drawn out over four years. It was really difficult. There was custody battle. and it was during this period of time that all these symptoms really worsened and she was not getting any relief from the multiple doctors she's been seeing. And so she arrived here. Her symptoms were really at this point, like anxiety and bloating and constipation. Secondarily, she was talking about, I also have had this long standing rash. It comes and it goes. and I get migraines. So of course I do a gut microbiome test. And I'm already, because of her symptoms, I was already thinking that, yeah, this is definitely gut issue, but the yeast vaginitis, the recurrent rash, the bloating, I was definitely think she had dysbiosis or imbalance. But I did suspect that she might have Candida because of the carb craving and the bloating and the rectal itch. so it was there. So I did some I did an additional test. I did Candida antibodies. So I I Candida can be hard to find.

Yeah.

And I really like to have something to hold on to. Yeah. When I make the diagnosis, something that is real. So here are the places I look. I did the Candida antibodies. The the complete diagnostic stool test that I did is going to measure is going to actually look for Candida using PCR testing. And it's then the other place I look.

I mean, your you just don't get it.

You know, so what we do at.

The Ultra Wellness Center is we look at things like antibodies to different foods, antibodies to yeast, we look at stool tests.

And then I also, you can also look at what we talked about earlier was the organics acid test. The organics acid test can actually look for metabolites of gut bacteria in your urine.

Or fungus.

Or fungus. Or fungus. And one of those metabolites that Candida makes and makes alone is D-arabinose. and so I checked for D-arabinose on our organics acid test, and that was enormously elevated off the chart. And so that was the, that's all I needed to know, understand that she had Candida.

So what you're saying is basically there's, there's tests that you can do where you can see if it's growing in the stool, whether there's the genetics of it in the stool, whether there's actually indicators in your blood from antibodies, but also you can look in your urine to see that these, these metabolites of fungus or even bacteria. can be absorbed from your gut and then they end up in your urine. So they're not human metabolites. So if you see this thing in your urine, it's not coming from you. It's coming from that critter in your gut. And that can be an issue. So we use basically the history, which is really important. All the symptoms we talked about, we have thrush or you have a white.

Coated tongue or all these things. I just have to emphasize one thing. Everybody gets a really, really, really deep history and a physical exam.

Right?

And I, you know what? And it's out of that that I cognate and I begin to put the pieces together. The narrative comes together and it can't come together unless you do those two things.

Yeah, that's really the story. And the test confirms it.

And then the test confirms where I was going and, you know, what I was thinking. And in this case, if the test didn't come back positive, right, then I wouldn't have, you know, maybe she didn't have candida. But I will say the final thing is that on how do you make that final decision, they have candida, Or yeast, your fungus. Candida fungus.

Candida is an umbrella term for fungus.

I think it's not just candida. It's not candida. It's the most common, but we can use the term yeast or fungus. I may say, you know what, I know the test came back negative. I know how hard it is to find, but clinically I think this person has fungus. I'm going to treat it. Absolutely.

I mean, some of them, they'll walk in mushroom, they have a white coating on their tongue and vaginal yeast infections and itching in their anus and they have eczema and they have blepharitis, which is crusting around the eyes, they have itchy ear. I mean, like there's a million symptoms that are from overgrowth of fungus or yeast. And even if their tests are normal, you still have to treat them.

Yeah.

And what's amazing is these people really get better.

They get better.

It's like one of those miracle things in functional medicine.

When you get it right, it is, you know, and that's why it's really important because it's maybe 10% of the people that come in have a fungal origin for their symptoms. And I will tell you most of the time it's just not that. It's usually just not that. It's usually gut dysbiosis or imbalances of bacteria to begin with. It's the fact that your nutrition's been really poor and they have multiple nutritional deficiencies. They live that really stressed out life. And that stress changes the gut microflora in such a way it makes you more susceptible to Candida. Absolutely.

And I think, you know, let's get into what we do for these patients. Because, you know, we talked about, you know, the kinds of symptoms that people have, the kind of testing we do that's a little bit different here at the Ultra Wellness Center. But this is not a hard problem to fix if you deal with the causes, right? And if you know what you're doing. So tell us, how do you approach these people through diet and the right.

Supplements and maybe medications? What do you do? Yeah, so those are the things that I look at. So again, I look at the general lifestyle and I start to think about, you know, where, what's gonna work. And I, it's gonna be all the lifestyle issues. So it's gonna be nutrition, it's gonna be sleep, it's gonna be exercise, it's gonna be stress reduction. Those are, those are right at the top of the list. Those are key for anybody. So nutrition becomes a key place. So when I think about Candida, I think about changing their diet. I think about treating it.

What do you do to the diet?

So the diet. So the diet, we want to take out, you know, sugars, processed carbohydrates. We want to take out. Because those are the things that feed your Candida. So there's some specific. Stop feeding them.

Yeah. Yeah.

So we're getting rid of, like, all the processed foods, all the sugar. We're going to limit alcohol and reduce stress.

Those are my top four things I do. Yeah. Okay.

And you don't have to go on this super extreme anti-candida diets that everybody talks about. Well, they're dangerous. I mean, they're not that they're dangerous, but. if you think about the anti-Candida diet, it restricts too many sugars, right? And the same thing with the, there's a diet called the GAPS diet. There's a diet called the SCD diet and the anti-Candida diet. One thing they have all in common is they're very restrictive of carbohydrates, almost to a fault, to the point where you might go into ketoacidosis or ketosis.

You wouldn't go into ketoacidosis.

Well, you go to, I'm sorry, I'm sorry. I mean ketosis. I mean ketosis. you may go on a tangent. Which isn't necessarily a bad thing. It's not. However, there are some studies that have shown that the antifungals we use, both the pharmaceuticals and the herbs that we use, do not work as well in a fasted state.

Interesting.

And also, neutrophils don't function as well, and neutrophils are very important in fighting the the candida and keep it from adhering to the the back the intestinal wall. Those are your white blood cells, right? And so so those diets, you know, that's one of the, you know, there's some research that points to them doing that. So I'm a little cautious about wanting to use such strict.

Yeah, but just getting rid of the sugar, the starch and processed carbs.

So that's what we do.

So we do basically here is we and you probably don't want to eat.

Any blue cheese, right? So we do those things. We get rid of the processed carbohydrates. We get we get rid of the starchy carbohydrates. We get rid of the sugars. We limit the alcohol. reduces stress. And, you know, there's so we do something a little bit like a low FODMAP diet. So we reduce those those foods that are easily fermentable. It's like onions and onions and asparagus and wheat would be examples of some of those foods you want to restrict. So now that's a great place to start. because good nutrition is good for everything. But generally we find, I find in my patients that it's not usually not enough. Candida is hard to treat and we need to then treat it. And typically we'll see, you need a weed killer. You need a weed killer. Yeah, you really do.

And what do you use?

So I'll typically start with herbals, you know, so there's caprylic acid, there's Undecylic acid, there is lurasidic acid, lurasidic acid.

Which is in breast milk and coconut. Yeah.

Right. Breast milk and coconuts. And then two spices that are very potent, and I think you need to be careful when you use them, are oregano and thyme.

Yes.

And they can be very, very helpful. Oregano is a great anti- Berberine can also be effective. Berberine also is an antibacterial. so it can be used to treat a bacterial overgrowth as well as a fungal overgrowth. So I will generally start there. I'll also add in some biofilm busters because these Candida, like other bacteria, they will congregate together, they will form a little town, they'll put up their umbrellas and be invisible to the immune system. So what is a biofilm buster?

So what is a biofilm? What is biofilm?

So biofilm is that. It's when they gather in a, it's like a big village of these Candida, they throw up their umbrellas.

It's like a protective tent over them.

Tent over them. So they're invisible to your immune system and they're, they're, they protect themselves against the antibacterial that you're going to use or the antifungal that you're going to use. So. So biofilms, when I have a patient, it's not getting any better. I'm going to pull out the bio. I'm going to pull out the biofilm busters. And those are going to be things like serapeptidase, nanokinease and. There's one more that I use that's slipping my mind right now.

That's okay. So we've got the antifungal herbs, we've got biofilm busters, and when do you decide to use medication and what do you use?

So when that's not working, then we oftentimes do have to go to medication. So I'll use Diflucan, Nystatin. Nystatin is sort of like the Xifaxan. If people have heard of SIBO, Xifaxan is an antibiotic. It's not systemically absorbed, it just stays in the gut.

Nystatin to babies.

Yeah, yeah. Pregnant women, babies can use nystatin. And so nystatin is a good choice if you're concerned about a patient's sensitivity to medications. So nystatin might be one of my starting points.

The most effective treatment I use is Diflucan. Yeah. Diflucan is one of those drugs that we hear is bad and bad for your liver. Doctors freak out about it. They don't want to take it for more than a day. But, you know, the old fungal drugs were dangerous. We used to learn about this in medical school. It was a drug called amphotericin. We call it amphoterrable. because it had all these side effects. But these newer drugs don't, especially if you're not taking a lot of other medications or there's drug interactions. And, and I prescribed probably more diflucan than any other drug I've ever prescribed in my entire medical career. And, knock wood, I really had no problems with it. People do get die off where they can feel like the, the yeast gets killed and then they'll get an immune response to that and they can feel kind of like flu-y for a little bit. But that you can kind of cut out with getting charcoal afterwards, a few hours later. And I think that this is really a very effective treatment for people who really need it. And I think I wouldn't be afraid of using it. And it's used for more than just a day, we use it for a few weeks or sometimes even a month.

Yeah, this, look, you know, Candida is one of those controversial areas in conventional medicine, but in functional medicine, you're going to come across people who have fungal infection, they have yeast infection, and it's having an enormous impact on their life. and you've got to be really cognizant of that, you need to test for it, and then you need to treat it appropriately. It is not that easy to get rid of it, it can recur. And so we have to be really diligent in helping our patients not just get rid of the Candida, but rebalance their nutrition, rebalance all of their lives because it's those things that led to the Candida infection in the first place.

Right.

So that's a big part of what I do is when I'm treating that, they're happy to feel better, they're glad that we figured it out, but that change in diet needs to stay that way.

Yeah, I mean, if you go back to eating all the starch and sugar, you're gonna just get a problem again.

Yeah, and so I think it's really important. It's an important topic. It was important enough for me to want to talk about it because I see it enough and see the impact it has and how wonderfully people can do. One of the places I see it most often, and I see some of the most dramatic turnarounds, is in our autistic kids.

I was just thinking about that.

You know, so autistic kids, one of the hallmarks of autism or part of their complex is, you know, gastrointestinal issues, you know, bloating, distension, diarrhea. That is like one of the biggest things that an autistic kid will struggle with. And it goes ignored by their primary care and their pediatrician.

Their psychiatrist, I mean, 95% of these kids have gut issues. How is it not relevant? and, and how is the brain in connected? Not connected.

So we do the testing and we, we, you know, we find that they, they have, you know, D-arabinose, like, off the charts.

Yeah.

And so that's that urine marker for yeast. That's a urine marker for yeast. And, and sometimes they have nothing that shows yeast, but they're, they're testing for their, their, their gut, their complete diagnostic stool evaluation comes back. They have a huge imbalance in their gut bacteria, and so. we're going to treat that. And those kids, if they're not getting better when I'm trying to fix their gut and I don't have positive testing for Candida, but I have all the others, you know, I have other symptoms, I put that kid on Diflucan, and I can't tell you how many kids have had, you know, amazing breakthroughs on their Diflucan.

It is, it's amazing. When you hit it right and it's the right patient in the right condition, it can be one of those miracle treatments. Yeah. so I, I think, you know, this is an incredible conversation about a very common condition that's often ignored or actually almost completely ignored by traditional doctors. It's one of those hot button issues that they freak out about and think you're a quack if you're talking about it. And I think there's been an overemphasis on Candida, but I think this in general, people who, who have this collection of symptoms by history, who have the right tests, when you hit it right, these people really get better. You cut out the starch and sugar, you use the herbal protocols. you sometimes use the medication in combination with an overall treatment of their health. And it's amazing how people get better. And that's what we do here at the Ultra Wellness Center. It's what you do, George, and what we've been doing for decades. And I think for people who struggle out there are not getting the answers to their health issues, we're here for you at the Ultra Wellness Center. And we see people from all over the world. We have all virtual consults now if you want. And I'm going to come here. We can do great video consultations and telemedicine. Which has been great. Everybody loves them. Yeah, people love them. and we can do all the diagnostics we need. We figured out how to do that. And just go to ultrawellnesscenter.com to learn more. And we'd love to see you. If you're struggling and you can't figure out how to get better yourself, maybe just cut out the starch and sugar and take some probiotics. There's a lot of other things we didn't talk about, but this is really an important topic for people to understand that there are ways to get better from things that are struggle street for them that aren't getting answers through traditional care. So hopefully we'll see you at the Ultra Wellness Center.

Thanks for joining us for this podcast.

A special episode of House Call. Thank you, George.

Thank you, Mark.

It's always a pleasure. And if you love this podcast, please share with your friends and family on social media. Tell us how you might think you have an issue with yeast. We'd love to hear and leave a comment and subscribe wherever you podcast and.

We'Ll see you next time on the Doctor's Pharmacy.

Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of favorite things to do and introduce to you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That's DrHyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

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