Now that you’ve heard my story in Part 1, what does the science actually say about eating to beat Candida? Is it possible to eat a vegan (or near-vegan) anti-Candida diet? How about one that’s also moderate in protein and fat?
Grab a green smoothie and buckle up, because we’re headed into the weird world of Candida and nutrition science.
The first thing I discovered in my search for a healthy plant-based anti-Candida diet is that there is much more to treating recurring yeast infections than just diet. (Ironic, huh?)
Diet doesn’t inherently cause yeast infections.1,2 Yes, excess refined carbs can increase yeast in the intestines of those who already have overgrowth,3 but diet alone isn’t likely to cause a yeast infection. Antibiotics, on the other hand, can. Lots of other factors play in too, like birth control pills, yeast allergy, and stress overload. So just changing diet likely won’t be enough to tackle chronic Candida, although it may help with symptom control. (Crandall packet)
Luckily, I found a great Candida treatment resource that covers all the bases, and I want to share it with you before we jump into diet.
A science-based guide to giving Candida the boot
Far from the supplement-pushing drivel on a lot of websites, the best resource I’ve found is a surprisingly humble-looking packet called “Overcoming Yeast Infections: A 10-Step Program of Self-Help and Medical Care.”
Written by Marjorie Crandall, PhD, a microbiologist and Candida expert, it contains a wealth of information on yeast overgrowth. For the skeptics out there (like moi), the packet is loaded with evidence-based information—she cites 100+ peer-reviewed studies! Better still, she provides a clear 10-step plan for diagnosing and treating all aspects of Candida-related disorders, including information to give to your doctor. Diet is only one step in her program (Step 8, no less). Ahead of diet are diagnostic tests, antifungals, Candida allergy, and more.¹
Please note I won’t make a penny if you buy Dr. Crandall’s packet. In fact, I don’t agree with her on everything, especially in the diet section, as you’ll see. However, I think most of her recommendations are solid, and she brings up some science-based methods for treating yeast infections that you and your doctor may not be aware of. She also cites credible science linking vulvodynia and interstitial cystitis to chronic, low-grade yeast infection. So if you’re ready to get better, check out Dr. Crandall’s website and consider buying her packet here. It’s $26 well spent.
Now, on to more pressing matters…
How can dinner make your lady bits itch?
A friend of mine asked me this last weekend (in so many words 😉 ). As I was talking, I realized that I had only the vaguest answers, which to my scientific ears sounded like voodoo. So, how does diet translate into very personal itching? (Or does it?)
I’m no expert, but I did find a number of ways food can wreak havoc in your britches. (!)
The intestine connection (literally, ew)
Many women with vaginal yeast infections also suffer from intestinal overgrowth of Candida.1,4 What’s more, the same specific strain of yeast tends to turn up in both the bowel and the vagina.4 Not to be gross, but it appears that the intestines can be a “reservoir” for vaginal Candida. (Ick.) In fact, one study found that 100% of women with recurrent vaginal Candida infection also had Candida in their stool.5 Apparently, no matter how clean you are, it’s a really short trip from one opening to the other. (Double ick.) So theoretically, anything (including food) that promotes yeast growth in the small intestine could promote ongoing yeast infections in your v-jay. (So much gag.)
Anyhoo, Candida love sugar. They happily ferment it into toxic alcohol and acetaldehyde, which can make you feel like crap generally. And since Candida can live in the small intestine (first stop after the stomach) they steal food that’s supposed to be for you—especially sugar, whether pure or broken down from starch—and use it to grow.1 (Crandall packet) Increasing yeast numbers means more yeast for your immune system to react to, whether you’re allergic or not. This might increase symptoms other places, like your nether regions, although I haven’t been able to find a good reference for that.
Candida overgrowth is also linked to “leaky gut,” which seems to result in food sensitivities. Intestinal yeast overgrowth likewise may be related to a controversial suite of symptoms known as “yeast syndrome,” which includes recurrent vaginal yeast infections.1
High blood sugar
Women with diabetes are at elevated risk for yeast infections, likely due to high blood sugar.6 However, even short-term spikes in blood sugar (which may not be connected to eating, since they can happen during the night!) can markedly worsen symptoms, at least in diabetic women.7 So it’s possible that anything that spikes blood sugar—like pounding a cupcake—could trigger itching down yonder. Refined carbs are likely the worst offenders, especially in conjunction with high fat intake, which can make blood sugar stay higher, longer.8 (Darn you, delicious cupcake!!!)
Women with recurrent yeast infections tend to suffer from allergies to yeast and mold, including Candida. (This seems to be true for me.) Unfortunately, Candida allergy not only renders you more susceptible to yeast overgrowth, but can give you worse symptoms, too. (Lucky me!) Given that Candida “looks” like other molds to your immune system, consuming any type of yeast, mold, or fungus might exacerbate symptoms, albeit indirectly when it comes to vaginal symptoms.1
Suboptimal zinc levels
Zinc is essential to proper immune function, and two small studies have found that zinc levels are significantly lower in women who get recurrent yeast infections. (One study didn’t find a relationship.) However, there are many ways insufficient zinc could leave someone vulnerable to yeast infections, vaginally and otherwise.9 Alas, those on a low-fat, plant-based diet need to be especially vigilant about zinc intake, and I haven’t been! Be sure to talk to your doctor before supplementing, though.
Standard anti-Candida diet advice
While all of these explanations for the connection between diet and yeast infections are interesting, none is airtight. However, that hasn’t stopped folks from espousing a low-carb, yeast-free diet for Candida overgrowth. Traditionally, that means healthy whole-food carbs, fruits, legumes, and starchy vegetables are out or severely restricted. (At least temporarily.)
But is that necessary? Or even advisable? What does the science say?
Science? What science?
Despite huge public interest, there are surprisingly few studies testing the effect of diet on yeast overgrowth, vaginal or otherwise. (Maybe I’m being a conspiracy theorist here, but if men got crotch itch even half as often women do, I think there’d be a LOT more data.) What peer-reviewed studies are out there are small and often suffer from design limitations. And—surprise!—none of them test the effects of a whole-food, plant-based diet.
Regardless, for the science nerds, here’s a quick summary of the studies I found and the diets they tested. Note that only the first has a “normal diet only” comparison (control) group; and the third one doesn’t have a control group at all! (Don’t dig science? Just scroll on past 😉 )
Sugar-free, yeast-free (SFYF): 116 patients with Candida overgrowth and multiple symptoms were given an antifungal or a placebo. They also chose to eat their normal diet or a SFYF diet: no refined sugar, fruit juice, alcohol, cheese, baked goods with yeast, vinegar, etc. Within each group (antifungal or placebo), the SFYF diet significantly improved symptoms. The antifungal + SFYF group did best of all, although the improvement over SFYF diet alone wasn’t statistically significant.10
Low-carb: 241 patients whose blood alcohol rose after eating sugar (indicating yeast overgrowth in the intestine) were placed on a low-carb diet for 8-18 weeks. (Sadly, I don’t have diet details.) In addition to diet, some patients got no drugs, some got an antifungal, and some got an antibiotic. (!) Among those who just ate a low-carb diet, 42% were “cured.” (They stopped producing alcohol when fed sugar.) However, of those on low-carb diet plus antifungals, 78% were cured. Antibiotics were bad news, though: even on a low-carb diet, only 7% were cured.11
No “excess” dairy/artificial sweeteners/sugar: When 100 women with high levels of certain sugars in their urine quit eating “excessive” amounts of dairy, artificial sweeteners, and sucrose (table sugar), they experienced a “dramatic” decrease in the frequency and severity of vulvovaginal yeast infections. (I don’t have more details, because I could only access the study summary.) However, they didn’t include a control group, so it’s hard to draw too many conclusions.12
Low-carb (80g/day), yeast-free (LCYF): Women with recurrent vaginal yeast infections and generalized symptoms were placed on a LCYF diet + antifungal drugs + Candida allergy shots, or they just took an antifungal. Women in the LCYF + antifungal +allergy shots group experienced “dramatic improvements in 28 symptoms,” including vaginal symptoms. However, it’s hard to know how much of a role diet played, since it wasn’t tested separately.1,13
While there’s not much to go on, all four studies agreed: Nix the refined carbs already! Eliminating dietary yeast and mold also helped in all studies that tested it. A low-carb (and thus high-protein and/or high-fat) diet could help, although only one study tested it independently.
However, it’s possible that by eliminating sugar and/or most carbs (especially junky refined ones), people were just plain eating healthier. That alone could boost their immune system and spruce up their gut flora! However, since none of these studies tested the effects of a healthy diet vs. a low-carb diet, it’s hard to know what led to their improvement. (Indeed, a tiny pilot study done in chronic fatigue patients, which might be linked to Candida, supports the idea that eating healthy is enough.14
With so little evidence to go on, it’s hard to know what to eat if you have a yeast infection! Given the the questionable health of low-carb diets—like an increased risk of death from all causes, according to a study that looked at 272,216 people—you’ll have to forgive me for not jumping on the low-carb bandwagon without a very compelling reason!15 (Note: It’s likely most of the protein increase on these diets came from animals, not plants.)
Dr. Crandall, of packet fame, does promote a lower-carbohydrate diet for yeast overgrowth. As much as I agree with the rest of the info in her packet, I’m not sure I agree with this advice. However, she does make an excellent point:
If you eliminate all carbohydrates in an attempt to overcome yeast infections, you will probably lose weight, become constipated, be unhappy because you cannot eat your favorite foods, and wonder why you are still suffering from yeast infections. No mystery here! You cannot starve yeasts in the gut because they can live on other nutrients in the lumen [gut] and intestinal wall. Diet is only one step…
And if you can’t starve yeasts in the gut, I’m guessing you really can’t starve them in your lady bits.
To be fair, her plan is much more reasonable than a lot of the other low-carb Candida diets. She recommends at least one serving of fruit per day, and one whole-food starch source, like legumes, winter squash, or whole grains, at every meal. She also advocates avoiding any foods you’re sensitive to, rotating foods to avoid new sensitivities, and designing your diet based on individual needs.1 So while I can’t endorse some of her advice (for instance, her conclusion that string cheese is a healthy snack) relative to some of the other “Candida diets” out there, hers is a step up.
Dr. Crandall also believes that “a vegan diet and the low carbohydrate diet are diametrically opposed.” In a sense I suppose she’s right; maybe that’s why plant-based diets are associated with lower risk of chronic disease and death from all causes.16 However, given that I’ve turned up some vegan anti-Candida diet plans that seem to combine the best of “traditional” (if unproven) Candida diets with plant-based nutrition, I disagree with her implication that you can’t recover from recurring yeast infections on a vegan (or near-vegan) diet.References
- Crandall M. Candida Information Packet. 2002, updated 2012.
- Foxman B. The epidemiology of vulvovaginal candidiasis: risk factors. Am J Public Health. 1990 Mar;80(3):329-31.
- Weig M, Werner E, Frosch M, Kasper H. Limited effect of refined carbohydrate dietary supplementation on colonization of the gastrointestinal tract of healthy subjects by Candida albicans. Am J Clin Nutr. 1999 Jun;69(6):1170-3.
- Lin XL, Li Z, Zuo XL. [Study on the relationship between vaginal and intestinal candida in patients with vulvovaginal candidiasis]. [Abstract only; full article in Chinese]. Zhonghua Fu Chan Ke Za Zhi. 2011 Jul;46(7):496-500.
- Miles MR, Olsen L, Rogers A. Recurrent vaginal candidiasis. Importance of an intestinal reservoir. [Abstract] JAMA. 1977 Oct 24;238(17):1836-7.
- Donders GG, Prenen H, Verbeke G, Reybrouck R. Impaired tolerance for glucose in women with recurrent vaginal candidiasis. Am J Obstet Gynecol. 2002 Oct;187(4):989-93.
- Donders GG, Bellen G, Mendling W. Management of recurrent vulvo-vaginal candidosis as a chronic illness. Gynecol Obstet Invest. 2010;70(4):306-21. doi: 10.1159/000314022. Epub 2010 Oct 16.
- Wolpert HA, Atakov-Castillo A, Smith SA, Steil GM. Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Diabetes Care. 2013 Apr;36(4):810-6. doi: 10.2337/dc12-0092. Epub 2012 Nov 27.
- Spacek J, Jilek P, Buchta V, Főrstl M, Hronek M, Holeckova M. The serum levels of calcium, magnesium, iron and zinc in patients with recurrent vulvovaginal candidosis during attack, remission and in healthy controls. Mycoses. 2005:48: 391–395. doi:10.1111/j.1439-0507.2005.01164.x
- Santelmann H, Laerum E, Roennevig J, Fagertun HE. Effectiveness of nystatin in polysymptomatic patients. A randomized, double-blind trial with nystatin versus placebo in general practice. Fam Pract. 2001 Jun;18(3):258-65.
- Hunnisett A, Howard J, Davies S. Gut fermentation (or the “auto-brewery” syndrome): a clinical test with initial observations and discussion. J Nutr Med 1990;1:33-8. →Summary in Eaton K. Gut fermentation: a reappraisal of an old clinical condition with diagnostic tests and management: discussion paper. J R Soc Med. 1991 Nov;84(11):669-71.)
- Horowitz BJ, Edelstein SW, Lippman L. Sugar chromatography studies in recurrent Candida vulvovaginitis. J Reprod Med. 1984 Jul;29(7):441-3.
- Truss CO, Truss CV, Cutler RB. Generalized symptoms in women with chronic yeast vaginitis: Treatment with nystatin, diet and immunotherapy versus nystatin alone. J Advancement in Med. 1992. 5:139-175.
- Hobday RA, Thomas S, O’Donovan A, Murphy M, Pinching AJ. Dietary intervention in chronic fatigue syndrome. J Hum Nutr Diet. 2008 Apr;21(2):141-9. doi: 10.1111/j.1365-277X.2008.00857.x.
- Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS One. 2013;8(1):e55030. doi: 10.1371/journal.pone.0055030. Epub 2013 Jan 25.
- Orlich MJ, Fraser GE. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings. Am J Clin Nutr. 2014 Jul;100 Suppl 1:353S-8S. doi: 10.3945/ajcn.113.071233. Epub 2014 Jun 4.