When the subject of yeast first arose in common conversation in the early 1980s, most doctors denied yeast could cause systemic problems in their patients and referred to practitioners who addressed this growing problem as quacks—even while acknowledging the existence of vaginal yeast infections in women and jock itch in men, as well as diaper rash and thrush in babies, all of which involve a type of yeast called Candida albicans.

With the growing number of dying AIDS patients in that era, those same naysaying doctors conceded that yeast and other fungi could indeed pose a systemic problem after seeing reports of budding yeast in the blood of AIDS patients viewed under the microscope, along with upper endoscopy reports documenting the presence of sheets of white accretions lining the throat and esophagus. The prevailing belief at that time was that systemic fungus only grows in patients with profound immune dysfunction.

We now know that all of us are vulnerable to yeast and other fungi due to overuse of antibiotics, eating meat from cows fed diets that include antibiotics, eating genetically modified and pesticide-laden foods, and overconsumption of sugar, simple carbohydrates and processed foods—ideal conditions for growing fungus where the colonies of beneficial bacteria have been decimated.

Annie, a 25-year-old graduate student in film production, came to my practice a few years ago complaining of frequent urinary tract infections. She had been prescribed six courses of various antibiotics in less than a year, all of which brought only temporary relief.

When I took a complete medical history, I discovered Annie had myriad complaints besides the ones related to her urinary tract infections. The complaints included extreme fatigue, “brain fog,” gas and bloating, itchy anus and vagina, rashes, and intense craving for sweets. The symptoms matched those found in conditions involving fungal overgrowth.

Around the time Annie had her first UTI—over a year prior to her appointment with me—she had become sexually active with a new boyfriend. It’s common for women to get post-sex urinary tract infections, also known as “honeymoon cystitis.” The fecal bacteria, like E. coli, that live harmlessly around the perineum, can get dislodged during sex and end up near the urethra. In women, unlike men, the distance the bacteria have to travel from the urethra to the bladder to set up their colonies is short.

Annie called her doctor and told of her symptoms. Over the phone, he prescribed Bactrim. He wanted to save Annie the hassle of coming in for an appointment and having to go to the lab and get the urine cultured; he had no doubts her symptoms were due to a bacterial infection.

After the first day on antibiotics, Annie’s symptoms disappeared. Three weeks later, she developed frequent urination and discomfort in her bladder. Her doctor said, in his opinion, the bacteria had returned because it was resistant to the Bactrim. He acknowledged he should have ordered a culture and sensitivity test in order to know what the organism was sensitive to. He prescribed Cipro, a powerful, broad-spectrum antibiotic. Annie took the antibiotic for five days and immediately felt better, which convinced the doctor she did indeed have a resistant organism which—in the doctor’s mind—explained why there was no long-lasting improvement with the first antibiotic.

A month later, Annie’s symptoms came back a second time with a vengeance. This time the doctor ordered a urine analysis as well as a culture and sensitivity test. The urine analysis showed white blood cells in the urine, but the culture showed no growth of bacteria. Since there were white blood cells in the urine, the doctor told her to take another course of Cipro, this time for fourteen days—“just in case.”

When her symptoms recurred a third time, Annie’s doctor referred her for a consult with a specialist. The urologist inserted a scope through the urethra to the bladder. The results showed a highly inflamed mucous membrane lining. A biopsy was taken and cultured. No bacteria grew in the culture medium. In spite of that finding, Annie was prescribed yet more antibiotics over the ensuing months before she made an appointment to see me.

With persistent questioning of the patient, I was able to piece together a working hypothesis of what happened.

Annie’s first UTI was most likely a true bacterial infection related to sexual activity. But the subsequent recurring symptoms were probably related to fungal overgrowth in the bladder from using antibiotics. She initially felt better each time she was on the antibiotics, which made her quite willing to keep taking them.

It’s not commonly known among doctors that antibiotics have a powerful anti-inflammatory effect—even when there is no bacterial infection involved—giving a false impression that the infection must have been bacterial in order to get such clear relief of symptoms. Although I have found nothing written about this phenomenon in the medical literature, I have observed this unusual property of antibiotics over 30 years of practicing medicine.

Each time Annie’s symptoms returned, they were progressively more painful, probably because the yeast had become imbedded in the wall of the bladder, causing pain, irritation, and frequent urination. The white blood cells in the urine were from inflammation.

Why didn’t the urine culture grow out yeast? Isn’t there a test for yeast infections, you might be wondering?

The urine culture is not designed for yeast testing, probably because it is very difficult to culture yeast in a petri dish. The absence of growth in the culture does not mean there are no fungi present.

As for the blood tests, they check for antibodies to the yeast. Since we all are exposed to yeast in varying amounts, the positive antibody results are not particularly helpful.

Yeast primarily thrive in the intestinal tract, making stool testing useful. But because yeast is so hard to culture out, if any yeast is present in the stool culture—even a small amount—it means that yeast overgrowth is a problem.

The best way to make a diagnosis of a yeast infection comes from recognizing symptoms that are consistent with fungal overgrowth. This method is referred to as a making a “clinical diagnosis.”

To test my hypothesis, I prescribed Annie an antifungal medication to take for a month. For the first few days, Annie felt like she had the flu, aching all over and deeply exhausted. I reassured her that the symptoms were related to “die-off.” As the yeast colonies begin to recede, they release toxic substances into the blood that make their host feel much worse before feeling better.

Fungi need sugar to survive. An effective survival mechanism the yeast use is secretion of a chemical that makes the host have irresistible, out-of-control cravings for sweets.

Annie braced herself and got through the first week of feeling exhausted, achy and irritable. By the second week, she started to feel much better and noticed that some of her other symptoms had improved as well, like the gas and bloating, the “brain fog,” and the out-of-control sugar cravings.

Below you’ll find the recommendations I gave to Annie:

• A change in the diet is essential in order to achieve lasting relief. After the anti-fungal treatment, the yeast will blossom again if they are given the right conditions, like a high sugar, high simple carbohydrate diet.

Fungus is never entirely eliminated. It’s a natural part of our microbiome, the colonies that reside in and on our bodies. The idea is to keep the growth of the colonies in check by not feeding them food they thrive on, like sugar, milled grains (bread and pasta), alcohol, fruit juice, and processed foods.

The anti-yeast diet resembles the paleo diet, but is more strict with the carbohydrates. It is virtually the same diet as an anti-cancer diet except that grass-fed meat and cultured dairy products are permitted on an anti-yeast diet. Both yeast and cancer cells need sugar to survive and multiply.

• Every effort needs to be taken to avoid being in a situation where antibiotics become absolutely necessary. Studies show that the gut can remain disrupted for up to a year after just one course of antibiotics.

• For prevention of upper respiratory infections, you can refer to the blog post about flu prevention and treatment. https://www.musingsmemoirandmedicine.com/2015/10/flu-prevention-and-treatment/

• For women who want to prevent “honeymoon cystitis,” drink 16 ounces of water after sex and take a dose of D-mannose, the active ingredient in cranberries. The E. coli bacteria ingest the D-mannose which makes the bacteria unable to colonize the bladder wall. About 85% of cases of “honeymoon cystitis” are caused by E.coli.

• Take probiotics daily. Test them periodically to see if they are alive by putting the contents of two capsules in warm milk of any kind, including coconut milk for the non-dairy people. If, after 24-48 hours, the milk begins to look like yogurt, they are alive.

• Consider including raw sauerkraut and raw kimchee (cultured vegetables) in your diet. They contain an abundance of beneficial bacteria. If you eat dairy products, then include freshly made yogurt and kefir in your diet. Store-bought cultured dairy products often lack viable beneficial bacteria.

• Include at least two tablespoons a day of coconut oil in the diet. One of the many virtues of this super food is its ability to quell yeast infections due to caprylic acid, one of the components found in coconut oil.

• Avoid genetically-modified and pesticide-laden foods. They destroy the beneficial bacteria and create “leaky gut syndrome” from the inflammation.

Annie gradually regained her health over the following year. After initially struggling with the anti-yeast diet, she is now a devotee of the new approach to eating because it has made her feel so much better. She no longer finds the standard American diet tempting—most of the time, that is.

The last time I saw Annie, she exuded vitality and clarity of mind. Her digestion functions well, with no more gas and bloating. And there are no more rashes, no more vaginal and anal itching, and thankfully no more UTIs.

In spite of the return of her health, Annie’s bladder irritation has not totally resolved yet. She developed what is known as interstitial cystitis, a chronic bladder irritation, probably a consequence in her case from the prolonged use of antibiotics. The yeast colonies imbedded themselves in the bladder wall, making it very difficult to totally eradicate them.

Annie still has some urinary frequency and discomfort, but much diminished and quite manageable. We are continuing to work on the problem through specific dietary changes and supplements.

Here’s to your good health!