GREAT post Martin.  Very informative, well-balanced, and humanitarian without neglecting the need for scientific rigor.   (Cross-posted to alt.psychology.personality since some personality typing will be discussed at the beginning - Note: I've set all followups to sci.med since most of my comments are more sci.med oriented and I'm sure most of the replies, if any, will be med-related.)   In article banschbach@vms.ocom.okstate.edu writes:  >I can not believe the way this thread on candida(yeast) has progressed. >Steve Dyer and I have been exchanging words over the same topic in Sci.  >Med. Nutrition when he displayed his typical reserve and attacked a woman  >poster for being treated by a licenced physician for a disease that did  >not exist.  Calling this physician a quack was reprehensible, Steve, and I  >see that you and some of the others are doing it here as well.    They are just responding in their natural way:  Hyper-Choleric Syndrome (HCS). Oops, that is not a recognized "illness" in the psychological community, better not say that since it therefore must not, and never will, exist.  :^)  Actually, it is fascinating that a disproportionate number of physicians will type out as NT (for those not familiar with the Myers-Briggs system, just e-mail me and I'll send a summary file to you).  In the general population, NT's comprise only about 12% of the population, but among physicians it is much much higher (I don't know the exact percentage - any help here a.p.p.er's?)  One driving characteristic of an NT, especially an NTJ, is their obvious choleric behavior (driver, type A, etc.) - the extreme emotional need to control, to lead, and/or to be the best or the most competent.  If they are also extroverted, they are best described as "Field Marshalls".  This trait is very valuable and essential in our society - we need people who want to lead, to strive to overcome the elements, to seek and thirst for knowledge, to raise the level of competency, etc.  The great successes in science and technology are in large part due to the vision (an N trait) and scientifically- minded approach (T trait) of the NT personality (of course, the other types and temperaments have their own positive contributions as well).  However, when the NT person has self-image challenges, the "dark-side" of this personality type usually comes out, which should be obvious to all.  A physician who is a strong NT and who has not learned to temper their temperament will be extremely business-like (lack of empathy or feeling), and is very compelled to have total control over their patient (the patient must be obedient to their diagnosis and prescription without question).  I've known many M.D.'s of this temperament and suffice to say I don't oblige them with a followup visit, no matter how competent I think they are (and they usually are very competent from a knowledge viewpoint since that is an extreme drive of theirs - to know the most, to know it all).  Maybe we need more NF doctor's.  :^)  Enough on this subject - let's move on to candida bloom.   >Let me tell you who the quacks really are, these are the physicans who have  >no idea how the human body interacts with it's environment and how that  >balance can be altered by diet and antibiotics...  Could it just be >professional jealousy?  I couldn't help Elaine or Jon but somebody else did.  You've helped me already by your post.  Of course, I believe that I have been misdiagnosed on the net as suffering from 'anal retentivitis', but being the phlegmatic I am, maybe I was just a little too harsh on a few people myself in past posts.  Let's all try to raise the level of this discussion above the level of anal effluent.   >...Humans have all  >kinds of different organisms living in the GI system (mouth, stomach, small  >and large intestine), sinuses, vagina and on the skin.  These are  >nonpathogenic because they do not cause disease in people unless the immune  >system is compromised.  They are also called nonpathogens because unlike  >the pathogenic organisms that cause human disease, they do not produce  >toxins as they live out their merry existence in and on our body.  But any of  >these organisms will be considered pathogenic if it manages to take up  >residence within the body.  A poor mucus membrane barrier can let this  >happen and vitamin A is mainly responsible for setting up this barrier.  In my well-described situation (in prior posts), I definitely was immune stressed.  Blood tests showed my vitamin A levels were very low.  My sinuses were a mess - no doubt the mucosal lining and the cilia were heavily damaged. I also was on antibiotics 15 times in 4 years!  In the end, even two weeks of Ceftin did not work and I had confirmed diagnoses of a chronic bacterial infection of the sinuses via cat-scans, mucus color (won't get into the details), and other symptoms.  Three very traditional ENT's made this diagnosis (I did not have any cultures done, however, because of the difficulty of doing this right and because my other symptoms clearly showed a bacterial infection).  Enough of this background (provided to help you understand where I was when I make comments about my Sporanox anti-fungal therapy below).   The first question I have is this.  Can fungus penetrate a little way into poor mucus membrane tissue, maybe via hyphae, thus causing symptoms, without being considered 'systemic' in the classic sense?  It is sort of an inbetween infection.   >Steve got real upset with Elaine's doctor because he was using anti-fungals  >and vitamin A for her GI problems.  If Steve really understoood what  >vitamin A does in the body, he would not(or at least should not) be calling  >Elaine's doctor a quack.  I was concerned, too, because of the toxicity of vitamin A.  My doctor, after my blood tests, put me on 75,000 IU of vitamin A for one week only, then dropped it down to 25,000 IU for the next couple of weeks.  I also received zinc and other supplementation, since all of these interrelate in fairly complex ways as my doctor explained (he's one of those 'evil' orthomolecular specialists).  I had a blood test three weeks later and vitamin A was normal, he then stopped me on all vitamin A (except for some in a multi-vitamin) supplement), and made sure that I maintain a 50,000 IU/day of beta carotene. Call me carrot face.  :^)  Hopefully, Elaine's doctor will take a similar, careful approach and to all supplements.  I'm even reevaluating some supplements I'm taking, for example, niacin in fairly large dosages, 1 gram/day, which Steve Dyer had good information about on sci.med.nutrition.  If niacin only has second-order improvement in symptomatic relief of my sinus allergies, then it probably is not worth taking such a large dose long-term and risking liver damage.   >survives.  If it gets access to a lot of glucose, it blooms and over rides  >the other organisms living with it in the sinuses, GI tract or vagina.  In   Though I do now believe, based on my successful therapy with Sporanox, that I definitely had some excessive growth of fungus (unknown species) in my sinuses, I still want to ask the question:  have there been any studies that demonstrate candida "blooms" in the sinuses with associated sinus irritation (sinusitis/rhinitis)?  (My sinus irritation reduced significantly after one week of Sporanox and no other new treatments were implemented during this time - I did not have any noticeable GI track problems before starting on Sporanox, but some for a few days after which then went away - considered normal).  BTW, my doctor dug out one of his medical reference books (sorry, can't remember which one), and found an obscure comment dating back into the 1950's which stated that people can develop contained (non-lethal or non-serious) aspergillis infestations (aspergiliosis) of the sinuses leading to sinus inflammation symptoms.  I'll have to dig out that reference again since it is relevant to this discussion.   >some people do really develop a bad inflammatory process at the mucus  >membrane or skin bloom site.  Whether this is an allergic like reaction to  >the candida or not isn't certain.  My doctor tested me (I believe a RAST or RAST similar test) for allergic response to specificially Candida albicans, and I showed a strong positive. Another question, would everybody show the same strong positive so this test is essentially useless?  And, assuming it is true that Candida can grow part-way into the mucus membrane tissue, and the concentration exceeds a  threshold amount, could not a person who tests as having an allergy to Candida definitely develop allergic symptoms, such as mucus membrane irritation due to the body's allergic response?  As I said in an earlier post, one does not need to be a rocket scientist, or have a M.D. degree or a  Ph.D. in biochemistry to see the plausibility of this hypothesis.  BTW, and I'll repost this again.  Dr. Ivker, in his book, "Sinus Survival", has routinely given, before anything else, Nizoral (a pre-Sporanox systemic anti-fungal, not as safe and not as good as Sporanox) to his new chronic sinusitis patients IF they have been on antibiotics four or more times in the last two years.  He claims that out of 2000 or so patients, well over 90% notice some relief of sinus inflammation and other symptoms, but it doesn't cure it by any means, implying the so-called yeast/fungus infection is not the primary cause, but a later complication.  He's also found that nystatin, whether taken internally, or put into a sinus spray, does not help.  This implies (of course assuming that excessive yeast/fungus bloom is aggravating the sinus inflammation) that the yeast/fungus has grown partway into the tissue since nystatin will not kill yeast/fungus other than by direct contact - it is not absorbed into the blood stream.  Again, I admit, lots of 'ifs', and 'implies', which doesn't please the hard-core NT who has to have the double-blind study or it's a non-issue, but one has to start with some plausible hypothesis/explanation, a strawman, if you will.   >If it's internal, only symptoms can be used and these symptoms are pretty  >nondescript.    This brings up an interesting observation used by those who will deny and reject any and all aspects of the 'yeast hypothesis' until the appropriate studies are done.  And that is if you can't observe or culture the yeast "bloom" in the gut or sinus, then there's no way to diagnose or even recognize the disease.  And I know they realize that it is virtually impossible to test for candida overbloom in any part of the body that cannot be easily observed since candida is everywhere in the body.  It's a real Catch-22.  Another Catch-22:  Those who totally reject the 'yeast hypothesis' say that no studies have been done (actually studies have been done, but if it's not up to a certain standard then it is, from their perspective, a non-study which should not even be considered).  I agree that the appropriate studies should be done, and that will take big $ to do it right.  However, in order to convince the funding agencies in these austere times to open their wallets, you literally have to give them evidence, and the only acceptable evidence to compete with other proposals is paradoxically to do almost the exact study needed funding.  That is, you have to do 90% of the study before you even get funding (as a scientist at a National Lab, I'm very aware of this for the smaller funded projects).  I'm afraid that even if Dr. Ivker and 100 other doctors got together, pooled their practice's case histories and anecdotes into a compelling picture, and approach the funding agencies, they would get nowhere, even if they were able to publish their statistical results.  It is obvious from the comments by some of the doctors here is that they have *decided* excessive yeast colonization in the gut or sinuses leading to noticeable non-lethal symptoms does not exist, and is not even a tenable hypothesis, so any amount of case histories or compiled anecdotal evidence to the contrary will never change their mind, and not only that, they would also oppose the needed studies because in their minds it's a done issue -  excessive yeast growth leading to diffuse allergic symptoms does not, will not, and cannot exist.  Period.  Kind of tough to dialog with those who hold such a viewpoint.  Kind of reminds me of Lister...   >Candida is kept in check in most people by the normal bacterial flora in  >the sinuses, the GI tract(mouth, stomach and intestines) and in the  >vaginal tract which compete with it for food.  The human immune system  >ususally does not bother itself with these(nonpathogenic organisms) unless  >they broach the mucus membrane "barrier".  If they do, an inflammatory  >response will be set up.  Most Americans are not getting enough vitamin A  >from their diets.  About 30% of all American's die with less Vitamin A than  >they were born with(U.S. autopsy studies).  While this low level of vitamin  >A does not cause pathology(blindness) it does impair the mucus membrane  >barrier system.  This would then be a predisposing factor for a strong  >inflammatory response after a candida bloom.    Aren't there also other nutrients necessary to the proper working of the sinus mucus membranes and cilia?   >While diabetics can suffer from a candida "bloom" the  most common cause of  >this type of bloom is the use of broad spectrum antibiotics which  >knock down many different kinds of bacteria in the body and remove the main  >competition for candida as far as food is concerned.  While drugs are  >available to handle candida, many patients find that their doctor will not  >use them unless there is evidence of a systemic infection.  The toxicity of  >the anti-fungal drugs does warrant some caution.  But if the GI or sinus  >inflammation is suspected to be candida(and recent use of a broad spectrum  >antibiotic is the smoking gun), then anti-fungal use should be approrpriate  >just as the anti-fungal creams are an appropriate treatment for recurring  >vaginal yeast infections, in spite of what Mr. Steve Dyer says.  Again, the evidence from mycological studies indicate that many yeast/fungus species can grow hyphae ("roots") into deep tissue, similar to mold growing in bread.  You can continue to kill the surface, such as nystatin does, but you can't kill that which is deeper in the tissue without using a systemic anti-fungal such as itraconazole (Sporanox) or some of the older ones such as Nizoral which are more toxic and not as effective.  This is why, as has been pointed out by recent studies (sent to me by a doctor I've been in e-mail contact with - thanks), that nystatin is not effective in the long- term treatment of GI tract "candidiasis".  It's like trying to weed a garden by cutting off what's above the ground but leaving the roots ready to come out again once you walk away.  The $60000 question is whether a contained candida "bloom" can partially grow into tissue through the mucus membranes, causing some types of symptoms in susceptible people (e.g., allergy), without becoming "systemic" in the classical sense of the word - something in between strictly an excessive bloom not causing any problems and the full-blown systemic infection that is potentially lethal.   >In the GI system, the ano-rectal region seems to be a particularly good  >reservoir for candida and the use of pantyhose by many women creates a very  >favorable environment around the rectum for transfer(through moisture and  >humidity) of candida to the vaginal tract.  One of the most effctive ways to  >minimmize this transfer is to wear undyed cotton underwear.    Also, if one is an 'anal retentive', like I've been diagnosed in a prior post, that can also provide more sites for excessive candida growth.  ;^)   >If the bloom occurs in the anal area, the burning, swelling, pain and even  >blood discharge make many patients think that they have hemorroids.  If the  >bloom manages to move further up the GI tract, very diffuse symptomatology  >occurs(abdominal discomfort and blood in the stool).  This positive stool  >for occult blood is what sent Elaine to her family doctor in the first  >place.  After extensive testing, he told her that there was nothing wrong  >but her gut still hurt.  On to another doctor, and so on.  Richard Kaplan  >has told me throiugh e-mail that he considers occult blood tests in stool  >specimens to be a waste of time and money because of the very large number of  >false positives(candida blooms guys?).  If my gut hurt me on a constant  >basis, I would want it fixed.  Yes it's nice to know that I don't have  >colon cancer but what then is causing my distress?  When I finally find a  >doctor who treats me and gets me 90% better, Steve Dyer calls him a quack.  As I've said in private e-mail, there are flaws in our current medical system that make it difficult or even impossible for a physician to attempt alternative therapies AFTER the approved/proven/accepted therapies don't work. For example, I went to three ENT's, who all said that I will just have to live with my acute/chronic sinusitis after the ab's failed (they did mention surgery to open up the ostia, but my ostia weren't plugged and it would not get to the root cause of my condition).  After three months of aggressive and fairly non-standard therapy (Sporanox, body nutrient level monitoring and equalization, vitamin C, lentinen, echinacea, etc.), my health has vastly improved to where I was two years ago, before my health greatly deteriorated. Of course, skeptics would say that maybe if I did nothing I would have improved anyway, but that view is stretching things quite far because of the experience of the three ENT's I saw who said that I'd just have to "live with it".  I'm confident I will reach what one could call a total "cure".  The anti-fungal program I undertook was one necessary step in that direction because of my overuse of ab's for the last four years.  (Note:  for those having sinus problems, may I suggest the book by Dr. Ivker I mention above. Be sure to get the revised edition.)   >...I have often wondered what an M.D. with chronic  >GI distress or sinus problems would do about the problem that he tells his  >patients is a non-existent syndrome.  Dr. Ivker started off having chronic and severe sinus problems, and his visits to several ENT's totally floored him when they said "you'll just have to live with it".  He spent several years trying everything - standard and non-standard, until he was essentially cured of chronic sinusitis.  He now shares his approach in his book and I can honestly say that I am on the road to recovery following some parts of it.  His one recommendation to take a systemic anti-fungal at the beginning of treatment IF you have a history of anti-biotic overuse has been proven to him time and time again in his own practice.  I'm sure if I commented to him of the hard-core beliefs of the anti- "yeast hypothesis" posters that he would have definite things to say, such as, "it's worked wonders for me in almost two thousand cases", to put it mildly. I also would not be surprised if he would say that they are the ones violating their moral obligations to help the patient.  Maybe those doctors who are reading this who have a practice and are confronted by a patient having symptoms that could be due to the "hypothetical yeast overgrowth" (e.g., they fit some of the profiles the pro-yeast people have identified), should consider anti-fungal therapy IF all other avenues have been exhausted.  Remember, theory and practice are two different things - you cannot have one without the other, they are synergistic.  If a doctor does something non-standard yet produces noticeable symptomatic relief in over a thousand of his patients, shouldn't you at least sit up and take notice? Maybe you ought to trust what he says and begin hypothesizing why it works instead of why it shouldn't work.  I'm afraid a lot of doctors have become so enamored with "scientific correctness" that they are ignoring the patients they have sworn to help.  You have to do both;  both have to be balanced, which we don't see from some of the posters to this group.  There comes a point when you just have to use a little common sense, and maybe an empirical approach (such as trying a good systemic anti-fungal such as Sporanox) after having exhausted all the other avenues.  I was one of those who the traditional medical establishment was not able to help, so I did the natural thing:  I went to a couple of doctor's who are (somewhat) outside this establishment, and as a result I have found significant relief.  Would it not be better if the traditional medical establishment can set up some kind of mechanism where any doctor, without fear of being sued or having his license pulled, can try experimental and unproven (beyond a doubt) therapies for his/her patients that finally reach the point where all the accepted therapies are ineffective?  I'd like to hear a doctor tell me: "well, I've tried all the therapies that are approved and accepted in this country, and since they clearly don't work for you, I now have the authority to use experimental, unproven techniques that seem to have helped others.  I can't promise anything, and there are some risks.  You will have to sign something saying you understand the experimental and possibly risky nature of these unproven therapies, and I'll have to register your case at the State Board."  Anyway, if my ENT had suggested this to me, I would've jumped on this pronto instead of going to one of those doctors who, for either altruistic reasons, or for greed, is practicing these alternative therapies with much risk to him/her (risk meaning losing their license) and possibly to the patient.  Such a mechanism would keep control in the more mainstream medicine, and also provide valuable data that would essentially be free.  It also would be morally and ethically better than the current system by showing the compassion of the medical community to the patient - that it's doing everything it can within reason to help the patient.  It is the lack of such a mechanism that is leading large numbers of people to try alternative therapies, some of which seem to work (like my case), and others of which will never work at all (true quackery).  I better get off my soapbox before this post reaches 500K in size.   >If taken orally, it can also become a major bacteria in the gut.  Through  >aresol sprays, it has also been used to innoculate the sinus membranes. >But before this innoculation occurs, the mucus membrane barrier system  >needs to be strengthened.  This is accomplished by vitamin A, vitamin C and  >some of the B-complex vitamins.  Diet surveys repeatedly show that Americans  >are not getting enough B6 and folate.  These are probably the segement of  >the population that will have the greatest problem with this non-existent  >disorder(candida blooms after antibiotic therapy).  What dosage of B6 appears to be necessary to promote the healing and proper working of the mucos memebranes?   >Some of the above material was obtained from "Natural Healing" by Mark  >Bricklin, Published by Rodale press, as well as notes from my human  >nutrition course.  I will be posting a discussion of vitamin A  sometime in  >the future, along with reference citings to point out the extremely  >important role that vitamin A plays in the mucus membrane defense system in  >the body and why vitamin A should be effective in dealing with candida  >blooms.  Another effective dietary treatment is to restrict carbohydrate  >intake during the treatment phase, this is especially important if the GI  >system is involved.  If candida can not get glucose, it's not going to out  >grow the bacteria and you then give bacteria, which can use amino acids and  >fatty acids for energy, a chance to take over and keep the candida in check  >once carbohydrate is returned to the gut.  I'd like to see the role of complex carbohydrates, such as starch.   >If Steve and some of the other nay-sayers want to jump all over this post,  >fine.  I jumped all over Steve in Sci. Med. Nutrition because he verbably  >accosted a poster who was seeking advice about her doctor's use of vitamin  >A and anti-fungals for a candida bloom in her gut.  People seeking advice  >from newsnet should not be treated this way.  Those of us giving of our  >time and knowledge can slug it out to our heart's content.  If you saved  >your venom for me Steve and left the helpless posters who are timidly  >seeking help alone, I wouldn't have a problem with your behavior.   Brave soul you are.  The venom on Usenet can be quite toxic unless one develops an immunity to it.  One year ago, my phlegmatic self would have backed down right away from an attack of cholericitis.  But my immune system, and my computer system, have been hardened from gradual desensitization.  I now kind of like being called "anal retentive" - it has a nice ring to it.  I also was very impressed by how it just flowed into the post - truly classic, worthy of a blue (or maybe brown) ribbon.  I might even cross-post it to alt.best.of.internet.  Hmmm...   >Martin Banschbach, Ph.D. >Professor of Biochemistry and Chairman >Department of Biochemistry and Microbiology >OSU College of Osteopathic Medicine  Thanks again for a great and informative post.  I hope others who have researched this area and are lurking in the background will post their thoughts as well, no matter their views on this subject.  Jon Noring   --   Charter Member --->>>  INFJ Club.