Debate Continues Over the ‘Yeast Connection’ : Health: Chronic infections may lead to a debilitating syndrome, some say. But others contend there isn’t enough evidence to prove that the disorder exists.
Ten years ago, Dorothy Senerchia developed arthritis in her right knee, then a host of medical complaints that frustrated her and baffled her doctors.
She itched, suffered from headaches and developed allergies to many foods. After years of searching for a cure, an allergist handed her a copy of the book “The Yeast Connection.”
“He asked me to read it and to come back and tell him if the problems discussed in the book ‘rang any bells’ for me,” she recalls.
The book, by Tennessee pediatrician William Crook, suggests that chronic yeast infections, which are caused by the fungus Candida albicans , can grow into a debilitating condition called chronic candidiasis syndrome, which causes dozens of symptoms.
Senerchia, a New York City planner, says she recognized herself immediately in the book, mirroring the claims of thousands of others who have read it.
The popularity of the diagnosis has been spurred largely by “The Yeast Connection.” The book has sold almost 1 million copies since its 1983 publication, and interest in Crook’s regimen for treating chronic candidiasis syndrome has spread to medical practitioners, nutritionists and chiropractors in every state.
But most physicians also have something to say about chronic candidiasis syndrome: They don’t believe it.
No one denies the existence of the C. albicans fungus. But from there, opinions clash.
There is still no evidence to show that the disorder is real, says Dr. John A. Anderson, president of the American Academy of Allergy and Immunology: “The advocates of this syndrome have never proven that it exists.”
C. albicans is a normally harmless yeast found in the mouth, intestinal tract and vagina. Under some conditions, it can multiply as a minor infection on the surface of the skin or mucous membranes. The most common type, vaginal yeast infection, usually occurs in women of childbearing age and produces a white, clumpy discharge and an intense itching sensation.
According to a number of health practitioners, an “overgrowth” of the yeast occurs in 30% of Americans; women are affected more often than men. This infection, they say, colonizes in the intestines and weakens the immune system.
It can cause a range of symptoms: fatigue, inability to concentrate, constipation, irritability, diarrhea, anxiety, dizziness, weight gain, muscle pain, psoriasis, hives, respiratory and ear problems, arthritis, infertility, impotence and bladder infections.
The syndrome was first described in medical literature about 20 years ago by Alabama physician Orian Truss. It reportedly is caused by the excessive use of antibiotics, hormones or birth control pills and by diets high in sugar, carbohydrates and yeast, which feed the yeast overgrowth.
“Few illnesses have sparked as much hostility between the medical community and a segment of the lay public as the chronic candidiasis syndrome,” says Dr. John Bennett in a recent issue of the New England Journal of Medicine.
The comments by Bennett, a researcher at the National Institute of Allergy and Infectious Diseases, accompanied a study on the syndrome that found that one treatment often prescribed for the disorder was ineffective.
But, he acknowledges, the controversy is far from over.
And that is the unfortunate bottom line for the many patients who, depending on one’s point of view, are either throwing their money away on useless treatments or are ignored by the mainstream medical community.
“There is no question in my mind that, clinically, it’s real,” says Dr. Murray Susser, a family practitioner in Santa Monica. He sees about one patient a day with chronic candidiasis syndrome, sometimes called candidiasis hypersensitivity.
“Most physicians who dispute candidiasis do so with great sincerity. But I believe they are wrong because they haven’t looked at it from the right point of view,” he says.
Medical editors of a new Consumer Reports book on health fraud disagree: “Many of these facts (that C. albicans is found in the intestines) are scientifically true. Nevertheless, it does not follow that an increase in yeast growth weakens the immune system.”
Consumer Reports is trying to debunk the idea of candidiasis syndrome. According to such critics, there is no proof that an overgrowth of C. albicans can cause a toxic or allergic reaction throughout the body.
In 1986, members of the American Academy of Allergy and Immunology attempted to quash interest in chronic candidiasis syndrome by calling it “speculative and unproven.”
And a study published in December in the New England Journal of Medicine casts even more doubt on the syndrome. In a double-blind study, the researchers tested 42 women who reported having chronic vaginal yeast infections and symptoms of the candidiasis syndrome. Half were given the anti-fungal drug nystatin, frequently prescribed for candidiasis; the other half received placeboes.
The study found that nystatin relieved vaginal yeast symptoms but had no effect on relieving other symptoms.
But syndrome proponents quickly assailed the study. According to Crook, patients are usually treated with anti-fungal drugs and a strict diet of yeast-free and low-carbohydrate foods. Patients in the study did not follow a special diet.
“All they did was to give them one thing, nystatin,” argues Crook. “All of us who are treating people for this problem, we put them on a diet first. If you continue to eat all the junk food--things you’re allergic to--the nystatin may not work.”
In the editorial accompanying the study, Bennett says the problem of proof rests with both sides. Although this study does not rule out the existance of the syndrome, he says, proponents have neither conducted nor published the necessary double-blind studies.
Syndrome proponents readily admit that the diagnosis is made in an unorthodox manner: It is suspected from the patient’s history and confirmed by response to treatment, which usually consists of anti-fungal drugs and an anti-yeast diet.
“If you go on an anti-yeast diet and take an anti-yeast drug and you feel much better, why argue with success?” Senerchia asks. “It will be years before there will be enough substantive scientific proof.
“I think some of (the controversy) stems from the fact that a doctor is traditionally taught that a patient who comes in with this many different symptoms has to be a hypochondriac. Another problem is a lot of the symptoms of candidiasis are symptoms of other illnesses.”
The range of symptoms is unusual, says the American Academy of Allergy and Immunology’s Anderson, who acknowledges that allergists frequently report seeing patients who complain of multiple, seemingly unrelated symptoms. Allergists and immunologists have little to offer them, however.
“We can reassure them, and try to take care of their complaints without having to rely on this explanation (chronic candidiasis syndrome),” he says. Many patients have psychological problems that lead them to believe they are physically ill, he adds.
Still, says Marjorie Crandall, a microbiologist from Torrance who suffered from the syndrome and now studies it, more practitioners are trying Crook’s drug-diet regimen for treating the illness.
“More and more doctors are recognizing that when they treat these patients this way, they get better,” she says. “The syndrome is very easily treated. It’s just not that complicated.”
And since more doctors are recognizing the syndrome as legitimate, it’s inappropriate for academic physicians to label the illness as “quackery,” Crandall says.
Experts on both sides say the controversy needs to be clarified for consumers’ protection.
Many people with the syndrome are unable to obtain health insurance reimbursement or disability payments, Crandall says.
And, Susser says, because it is hard to find a doctor who believes in the syndrome, many patients are seeking treatment and advice from unqualified people, like health food store employees and untrained nutritionists.
“This has become a fad thing,” he says. “Because the medical profession has not taken hold of this, it has drifted out and become the charge of nonqualified practitioners.”
