Ep 188 Candida yeast: Here, there, and everywhere

None of us are ever truly alone. Our bodies are home to untold numbers of microbes, chilling on our skin, in our guts, throughout our respiratory tract, inside our bellybuttons, under our fingernails, and beyond. For the most part, we live in harmony with these critters, never giving them a second thought. But occasionally, they may grow a bit too friendly, taking advantage of our hospitality to grow and spread with abandon. Candida yeasts are especially fond of this tactic, leading to millions of infections around the globe each year, many of which can cause significant illness or even death. In this episode, we explore the characteristics of these yeasts that make them so prone to overgrowth, how severe infections can develop, and why one of medicine’s greatest achievements may have helped usher in this new fungal era.

Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAu

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:00):
Let me take you back to when I was a weird,
nerdy fourteen year old. I'd recently started menstruating and was
incredibly self conscious about managing my periods At school. The
popular girls would congregate in the school bathroom, so they'd
hear the unzipping of my bag and the crinkle as
they unwrapped sanitary products from their packaging. I was terrified

(00:20):
about what gossip would be sped around school if people
found out that time was on my period. I made
the decision to avoid changing my sanitary products at school.
This created a lovely, warm, moist environment for yeast, so
it's no surprise that I got a yeast infection or thresh.
If you have not had the pleasure, it's like an

(00:41):
infected horsefly bite. It's an incessant itch that is constantly
screaming for attention. I couldn't sleep, It hurt to pee,
I couldn't concentrate on anything except for the pain of
the itch. This coped with being a teenager with hormones
coursing through my body. The shame and self loathing of

(01:02):
my poor decision made this a really distressing time. To
add to my humiliation, I had to tell my GP
about my symptoms, but I lacked the polite vernacular to
do so. I eventually stammered that I had an itch
at the front of my bum, and the GP took
pity on me and my mum was able to take

(01:23):
over the consultation. I was asked no further questions and
no invasive tests were performed. I was given a prescription
for Caniston, and this was the first time I had
ever used a pessary and had no idea whether I
was in certy in correctly. However, I recovered and became
scrupulous about my vaginal health and changed my sensory products

(01:45):
at least every four hours, as recommended. Fast forward abound
ten years. I'm in a sexual relationship and I get
the itch. I assume it's thrush and get Caniston over
the counter at the pharmacy and carry.

Speaker 2 (02:00):
On with my day.

Speaker 1 (02:02):
The thrush clears up for a while, but then it
comes back, so I called the GP and they tell
me to go to the sexual health clinic. To do this,
I have to take annual leave to travel there in
the opening hours. Even then, the only accommodated walkins, so
I may not have been seen. If these barriers were
not enough. I was also extremely embarrassed with dou whole

(02:23):
idea of going to a sexual health clinic. Eventually, I
saw a GP who gave me a swap and confirmed
I did have recurrent thrush. My partner at the time
laughed and told me that thrush was no big deal,
which is probably because he.

Speaker 2 (02:38):
Couldn't catch it.

Speaker 1 (02:40):
Because my thrush was recurrent, the GP gave me a
blood test for diabetes, which came back negative. There was
no obvious cause, so I fell through the cracks a
little bit.

Speaker 2 (02:52):
The GP had never asked about my environment.

Speaker 1 (02:56):
If they had, we probably would have figured out the
cause pretty quickly. In the office, my desk was positioned
directly underneath the air con and I really feel the cold,
so the office administrator had very kindly given me a
little heater to put underneath my desk. I like to
have it snuggle between my knees, which created a really

(03:17):
lovely warm environment for myself.

Speaker 2 (03:19):
And also for the east. At the time, I didn't
put two and ty together.

Speaker 1 (03:26):
I just carried on in discomfort for the next few months,
with the added expense of Caniston on my regular shopping list.
There were other knock on effects My sleep suffered, my
relationship suffered. My partner at the time really struggled with
the reduction of intimacy. So on the night when saying

(03:47):
no wasn't worth the drama, I would scrab my legs,
close my eyes and think of England as the saying goes.
For those who haven't had the pleasure, it feels like
having sandpaper shoved inside that whole spy bite described earlier.
Several years later, I'm happily single, I work from home
and can control my environment, and I am thrush free.

(04:09):
I found thrush to be extremely isolating, and I hope
that if anyone can relate to my story that they
find comfort that they are not alone. Thank you very
much for listening.

Speaker 3 (05:06):
You know, I feel like that story really, it like
exemplifies some of the shame that's surrounding things like yeast infections. Yeah.

Speaker 4 (05:17):
Yeah, I feel like no one wants to talk about
east infections, right.

Speaker 3 (05:21):
And I know that's so common. I'm gonna say, like
literally every person with a vaginant with vagina has had
a yeast infection.

Speaker 5 (05:27):
Seventy five percent actually almost every time. That is pretty
much close to everyone.

Speaker 4 (05:31):
Yeah, yeah, yeah, Thank you so much for sharing your
story with us and everyone listening.

Speaker 3 (05:38):
We really appreciate it. Yeah, thank you, thank you.

Speaker 4 (05:41):
Hi. I'm Aaron Welsh and I'm Aaron on An Updike and.

Speaker 3 (05:45):
This is this podcast will kill you.

Speaker 4 (05:47):
Welcome to yeast infections.

Speaker 3 (05:50):
And I mean east infections.

Speaker 4 (05:52):
It is broader.

Speaker 3 (05:53):
Yeah, well I feel like but it's all yeast or
yeast like and so it's weird. Yeah yeah, and not
just Canada ALBACNS Canada Orris Canada. Those are the only
two I know right now. It's a point in our conversation.
I can't believe we haven't done this.

Speaker 4 (06:13):
I can is simply too long. That's good, it was.
Our list is long. And you know we're doing it now.
That's all we can say. We're doing it now.

Speaker 3 (06:28):
I learned a lot, we're about to learn some more,
and we're about to tell you about.

Speaker 4 (06:34):
A recipe for our quarantquarantine or please super rita today.

Speaker 3 (06:39):
Super rita. Yeah, actually this you can make it a
quarantine if you want.

Speaker 4 (06:42):
Sure.

Speaker 3 (06:43):
It's called a cant Yeah.

Speaker 4 (06:47):
The candid shot or just a candid shot.

Speaker 3 (06:49):
Well, the only reason I was thinking a candid shot
is because candid duh. And then what happens to that
a we just move it over. But the candid shot.

Speaker 4 (06:57):
In your grammar I like it.

Speaker 3 (06:59):
I mean than a candid shot is fairly simple. It
is like rose soda and rhubarb.

Speaker 4 (07:07):
I was gonna say, like, you just stand there and
someone takes your pictures.

Speaker 3 (07:10):
Sorry, that wouldn't be candid. No, you're right.

Speaker 4 (07:16):
Any Ways, you can find them very complicated recipe for that,
plus e Brita and if you want to add alcohol
a quarantine on our website, this podcast will Kill You
dot com and our socials? Are you following us on socials?
Aaron's making videos of these drinks.

Speaker 3 (07:31):
Or poor videos. Yeah, not very good, but they exist.

Speaker 4 (07:34):
We're trying trying things things Instagram, TikTok, Facebook, website.

Speaker 3 (07:42):
Webs podcast will kill You, dot com transcripts, links to
merch links to bookshot dot org, affiliate account, links to Goodreads list,
links to music by Bloodmobile, the sources for each and
every one of our episodes. There's also embedded YouTube videos there,
so if you check out our oh you doing that.
Sometimes I'm a little bit late because I have to

(08:02):
wait for the day that they publish. It doesn't matter.
They're there and some other things that contact us form.
Thank you everyone who has submitted your story for a
first hand account using our first hand account form.

Speaker 4 (08:16):
Just know it could be years before we contact you,
but we read them all.

Speaker 3 (08:19):
But we do read them all.

Speaker 4 (08:20):
Yeah, yeah, I think great, that's it.

Speaker 3 (08:23):
You did a great job. Thank you.

Speaker 4 (08:26):
Do you want to hear about the biology of Canada?

Speaker 3 (08:28):
Of course I do.

Speaker 4 (08:29):
Let's take a break and get into it. So the
star of today's show is a fungus, and as we've

(08:50):
learned in previous fungal episodes, funk i tend to be
a little bit complicated. They do, they really do. And
in the case of Canada, often people cited as a yeast, right,
we think yeast infection, and a yeast is a single
celled fungus, right, like the kind of use that you
use for bread. But Canada also exists as a filamentous

(09:13):
mold with its little hiphi or sometimes pseudo hyphie branching out.
So it's really quite multifaceted, and it might not be
surprising that, in part because of that, Canada can cause
a really wide range of potential infections, not just vaginal
yeast infections. There are several different species of Canada that

(09:35):
cause infections in humans, the most common of which is
Canada albacans, but there are I think there's a push
to group all of the other ones as like non
albacans Canada or none nac and acy non albcans Canada yeast. Anyways,
and these actually some of them have been growing in
abundance and posing a growing concern to infectious disease specialists

(09:58):
and in public health official and infection preventionists in hospitals.

Speaker 3 (10:03):
Well, because that's what I was wondering, So why would
you like, are all non albacans Canada as pathogen like
equally pathogenic and problematic?

Speaker 4 (10:13):
All of them tend to be more apt to resistance,
which is one of the big concerns about them.

Speaker 3 (10:21):
Yeah, very interesting.

Speaker 6 (10:22):
Yeah.

Speaker 4 (10:23):
So the kind of most notable ones, and there are
more than these two, but kind of the most notable
ones are Canada Orus and we'll talk more about that later.
And then what used to be called Canada glebrata but
what is now has been reclassified as NA Gonna sayomics glebratis,
okay uh. And I think that's also part of why
they're saying call everything non albacans because it's like they've

(10:47):
been renaming some things, which is important but also gets confusing.

Speaker 3 (10:52):
Yeah.

Speaker 2 (10:52):
Yeah.

Speaker 4 (10:53):
And then also Canada parasilosis, so that's the other one, sure,
And all of three of them do tend to have
more resistance to antifungals than Canada albacans. And so we'll
talk a little bit more about them a little bit,
and you can ask questions and I might have the answers.
But for most of this episode, especially for the like

(11:13):
pathogenicity part of things, I'm going to focus on Canada albacans.
It is by far the most common, something like ninety
percent of us are colonized right now as we speak,
on our skin, or in our mouths, or in our
vaginas or in our guts because it can live there too.
So Canada is or causes what we often call an

(11:34):
opportunistic infection, meaning that when the opportunity arises, it will
cause infection, and when it does not arise, it simply
coexists with.

Speaker 3 (11:43):
Us and maybe even beneficial.

Speaker 4 (11:47):
Maybe though I didn't research that at all. It's okay,
I have a paper love it, and it lives not
just on our skin and in our mucous membranes, but
also in the environment, and mostly just hangs out there
a little bit unobtrusive until it becomes a problem. I
think of it as just getting too big for its

(12:07):
breeches and deciding to take over the place, writing executive orders,
and all of the judges and other lawmakers are nowhere
to be found, can't keep it in check.

Speaker 3 (12:17):
Just kidding, I guess this is fine for me to
take over. No one's here, like.

Speaker 4 (12:23):
Yeah, no one else is here, I'll just move in.

Speaker 3 (12:26):
Yeah.

Speaker 4 (12:26):
So let's talk about what kinds of problems it can cause,
because it's really varied, and not all Canada infections are
created equal. There are broadly two big categories of candidal infections.
There's muco cutaneous infections, so skin and mucus membranes, and
then there are systemic infections. You can probably guess which

(12:47):
one is more severe the most I don't even know
if this is I don't know if it's true to
say the most common, but probably like the thing that
certainly I think about in that most people probably think
about with Canada is a vaginal infection or volvovaginal candidiasis.
And we kind of said this already, but something like,
seventy five percent of people with a vagina will have

(13:08):
candidiasis at least once in our lives. Six to ten
percent of us may have recurrent volvovaginal candidiasis, which is
usually defined in the literature as more than four per year,
with resolution of the symptoms in between each episode.

Speaker 3 (13:25):
Okay, not just like persistent, Like so, I mean, okay,
that is the chronic part. Are there? How long?

Speaker 2 (13:31):
Oh?

Speaker 3 (13:31):
Okay? Never mind? Am I getting ahead of things already?

Speaker 7 (13:34):
Yeah?

Speaker 4 (13:34):
You're asking a lot.

Speaker 3 (13:35):
Of questions like how long does the east infection last?
How long does treatment? How long does it take to
resolve things? How long does it? Yeah, does it ever
self resolve?

Speaker 4 (13:44):
Yeah, certainly can certainly can self resolve. How long it
lasts just totally depends on the person and their immune
system and what kind of treatment they get, if they
get treatment. Treatment depends on the situation. It can be topical,
so sometimes we use like vaginal suppositories or vaginal creams,
or it can be oral and that's usually a shorter
course unless it's a more resistant strain or you have

(14:06):
recurrence or something like that.

Speaker 3 (14:07):
Then sometimes you need a.

Speaker 4 (14:08):
Prolonged course of oral antifungals.

Speaker 3 (14:12):
Okay, what real quick one question? Okay, So, for the
people who have recurrent yeast infections, what is driving that recurrence?
Isn't that a great question? We don't know. We don't know.

Speaker 4 (14:24):
Okay, Yeah. What I can tell you a little bit about,
since I haven't even mentioned it yet, is what the
symptoms of a vaginal uast infection are.

Speaker 3 (14:31):
Sorry, I just got excited.

Speaker 4 (14:34):
I love it, Aaron, don't ever apologize for your excitement.
But again, most of us is probably other things. Yes,
most of us have probably experienced this. We can see inflammation,
we see a white, chunky, cheesy kind of cottage cheese discharge, itching,

(14:54):
burning pain. And this is an infection that is very
easy for people to and by people I mean the
people not experiencing it. But it has a substantial economic
and morbidity burden. And we'll talk a little bit more
about that later on in this episode. The risk factors

(15:14):
for like why do people get YaST infections and some
people don't? Or when does someone get a east infection?
Risk factors can include poorly controlled diabetes. Sometimes we see
associations with sexual activity, but it's not considered by any
means of sexually transmitted infection because again this is like
a commensal We also can see an increase in cases

(15:34):
with increased estrogen states, so like during pregnancy and things,
But by far the most common is antibiotic use. Yeah,
and that's true for a lot of candidal infections, not
just global vaginal infactions, right, But it's not just the vagina.
Our other mucous membranes can often get infected. So we

(15:56):
can see oral or esophageal candidiasis, which at least east
in the US we often call thrush, and I think
that they call thrush like a variety of candidle infections
in other countries too. But that is when you get
infection of the tongue, the oral mucosa, the gingabus, or
your gums or your throat or esophagus, and you usually

(16:16):
will see this kind of off white yellowish. It can
almost be like almost so dark that it looks kind
of brownish or blackish, just depending on like how long
it's been there in things. But this plaque that forms
in the mouth or in the throat, most of the
time with these infections, we see them with some type
of immunal compromising condition, so something like HIV, AIDS or

(16:41):
chronic steroid use, including yes, inhaled corticosteroids if you're not
rinsing your mouth, and that's why you're supposed to rinse
your mouth after you use like a inhaler.

Speaker 3 (16:49):
That's interesting, okay, okay.

Speaker 4 (16:51):
Or conditions that cause like a reduction in saliva, which
is going to help to wash out the yeast that's
in your mouth and keep it moving.

Speaker 3 (16:58):
What would that what reduces sali?

Speaker 4 (17:00):
Oh, something like chogrin syndrome, which is quite rare. But
then there's other things that I don't know, other specific
conditions where people might have less saliva, or people who
wear dentures I think too, are at higher risk of
oral candidiasis. Okay, But we can also see it on
our skin or in our nails. We can get intertrigo,
so like in the skin folds maybe say axila growin

(17:21):
diaper rash for babies. You can get it on the penis,
we call that balinitis. You can also get it on
the nails, so either with like an ingrown nail, so
we call that paranikea or onycomycosis, which is like the
nail infection.

Speaker 3 (17:37):
Is that like on top of your nail or under
your nail or like, how does that happen?

Speaker 4 (17:41):
It's like within the nail itself, rail itself. Yeah yeah, okay, yeah,
it's here, it's there, it's everywhere. So given the right
set of circumstances, it can absolutely flourish, and sometimes it
can really go too far and cause a systemic or
invasive infection inside of our box. The most common and

(18:02):
most serious of these invasive candidal infections is called candidemia,
which is a bloodstream infection, so yeast growing in our bloodstream,
and this has a mortality rate of thirty to forty percent,
depending on how you calculate it. And that's today, and
that's in high income countries.

Speaker 3 (18:20):
And that's with all the treatments available.

Speaker 4 (18:22):
Exactly yep, yeah wow. And part of that is because
of just how hard it is to diagnose and treat
these infections, especially once they've gotten into our bloodstream, but
also because the vast majority of people who end up
with a bloodstream infection are very stick to begin with.

(18:42):
So we see this really commonly in things like icee use,
when people are already you know, their immune systems are
kind of at their limit and things like that. Once
someone has an invasive candidal infection. They can end up
with a number of other places that this candida in
effects thereafter. So you can get an infection in the

(19:02):
eye and it can cause candida end ophthalmitis, which can
potentially cause permanent blindness. It can go into the heart
and cause endocarditis, so infection of the heart and.

Speaker 3 (19:14):
The valves of the heart.

Speaker 4 (19:15):
Okay, it can get into the central nervous system, and
we see this commonly in premature newborns something like fifteen
to twenty percent of the time if a premi ends
up with invasive candidiasis, it will end up in their
central nervous system, so with ameninditis or and encephalitis, I know.
And then especially after surgeries or other like abdominal procedures,

(19:37):
people can get abdominal candidiasis and that can result in
like a fungal abscess or can sometimes infect the liver
or the spleen and in those cases can sometimes cause
a really prolonged infection that's really hard to treat.

Speaker 3 (19:50):
Do we have a more granular answer as to how
this happens. Then there's a breakdown immunosuppression and things just
sort of bill over. It's a good question, not not
a super more.

Speaker 4 (20:03):
Granular one than that. Okay, there's always, I mean almost always,
there's going to be some I say almost just a hedge.
But realistically there's always going to be some kind of
like precipitating events, right, whether it's some other infection, whether
it's you know, a bone marrow transplant, a solid organ transplant,
you're on immunosuppressive drugs, you have, you know, HIV AIDS,

(20:24):
like you're born with an immunodeficiency. So many potential conditions
that lead someone to be more susceptible, and then it's
like those right set of circumstances. The other thing that's
very commonly predisposed of someone to an invasive infection, especially
a bloodstream infection, would be having indwelling lines. So if
you have ports, if you have catheters, as we'll see,

(20:46):
Canada forms biofilms very easily, and so they can colonize
and form a biofilm on those indwelling lines and then
put you at risk for invasive infection because it's just
bopping off little Yeasti's from the bio film.

Speaker 3 (21:01):
I feel like. So on this podcast, we have talked
about a few other opportunistic pathogens that tend to just
hang out and then crop up when something is a
little bit out of balance, there's dysbiosis whatever. And I
do we know why Canada rather than staph oreus? Or

(21:21):
why Canada rather than strap? You know, like, what is
that deciding factor?

Speaker 4 (21:26):
I don't, Well, I don't think it's always an either
or sure of course not yeah, but yeah, I don't.

Speaker 3 (21:33):
I don't know.

Speaker 4 (21:33):
It's a good question, I mean, and it could be
any of those. So it might just depend on that individual.
What is their skin more colonized with, what do they
happen to have on their bodies, what other antibiotics are
they being exposed to, what happens to gain that foothold
to begin with, or what other you know, Because our
immune systems respond to bacteria and to fungi in different ways.

(21:55):
So what type of immunal compromising condition do you have?
And does it leave you more susceptible to fungus because
your immune system is just not as good at getting
at that fungus versus a bacteria or something like that.
Are you already on all the antibiotics possible and so
you've killed all those and now only the yeast are left.

Speaker 7 (22:13):
Yeah.

Speaker 3 (22:14):
Yeah, and as a.

Speaker 4 (22:16):
Fungus, Canada is already in some ways kind of harder
for us to fight off compared to some bacteria because
it's a eukaryote rat, right, so it's a little bit
closer to us, So it's harder for us to have
anti fungals. It's harder for our body to recognize it sometimes. However,
Canada is also special and has quite a number of

(22:36):
virulence factors that facilitate its ability to infect us and
cause disease. For one thing, it can do that switching
thing that I mentioned at the top. It can exist
as a yeast or as this filamentous hyphie form depending
on its environment, and this allows it to disseminate widely
when it's a yeast, right, it's really hardy. It can

(22:57):
exist in the environment, it can beat bop but between people,
and then it allows it to invade through our epithelial
barriers when it's in its highfel form, and then that
also allows it to evade a lot of our immune responses.

Speaker 3 (23:11):
Okay, so the highful form does impact our immune like
its munogenicity or something.

Speaker 4 (23:16):
Detection majorly majorly, And so it's really the highful form
that we tend to see that ends up being the
reason that we have invasive disease.

Speaker 3 (23:25):
And so are all canada albukens, individual you know, cells
or whatever capable of this transformation.

Speaker 4 (23:33):
As far as I know, yes, And there are differences,
and it does seem like the switching part of it
is what makes them so good at causing disease, because
when you breed strains that are only highful or only yeast,
they're not quite as good. But in general they all
can do both. They're quite adept like that. Canada also
has a bunch of proteins that we call adhesions, which

(23:55):
I feel like we've talked about this who knows on
what episode, But they're basically sticky protein that allow it
to make these biofilms and to colonize places like our
skin and mucus membranes and also things like catheters, pick lines,
like all of these lines that, especially if someone is
already ill and in the ICU, they usually have quite

(24:16):
a lot of lines and a biofilm. For anyone who's
forgotten the glory that is biofilms, they're these really complex
assortments of a bunch of different microorganisms that end up
forming their own protective barrier, this little extracellular matrix that
completely blocks our immune response from accessing them, which means

(24:38):
that they can continue butting off these little yeasti's or
having their little filamentous forms just kind of creep out
and go invade deeper into our bloodstream. For example, where did.

Speaker 3 (24:48):
We was it Legionnaire's disease? Where we talked a lot
about it.

Speaker 4 (24:51):
Definitely talked about them yeares. But something since then too,
because that was a long time ago by camera. Yeah,
I can't remember what it was someone else, do you remember?
I have a better memory than us. But lastly, they
also have a bunch of enzymes that they can secrete
these this fungus to help break down our endothelial cell

(25:11):
barriers and damage our cells and hide from our immune system.
And what's so fascinating is that part of the way
that Canada does this is actually by recognizing some of
our metabolic cues. So they're sensing what's going on in
their environment, aka in our bodies, and changing the way
that they grow, changing the structure of their own cell wall.

(25:35):
They are just really really well adapted to our human bodies.
And probably the two biggest challenges when it comes to
dealing with candidal infections, especially the severe ones, but even
you know, mucocutaneous infections, which I'm not saying those are
not severe, just in comparison to bloodstream infections. It's diagnosis

(25:55):
and treatment, and the diagnosis of Canada is really challenging
in part because the gold standard is to grow it
in culture, and these grow really slowly. They take a
really long time to grow in culture, and our culture
methods are imperfect. So if you have, say a low abundance,
you might get negative cultures even though you have plenty

(26:18):
of yust growing in your body.

Speaker 3 (26:20):
Well, and then how do we because it's a commensal
and it's on you said ninety over ninety percent of people,
how do we know whether detection of Canada is a
problem or like regular growth or overgrowth? Great question.

Speaker 4 (26:34):
So, yeah, you can have false positives and false negatives,
both directions, right, depending on exactly what site you took
it from, depending on how you took the samples. In general, though,
it does not belong in our blood. So if Canadas
are growing for doing blood sample, of course, yeah, but
you're right if it's from like a skin sample, is
it overgrowth or is it not? And some of that
comes down to like clinical diagnosis as well too, what

(26:57):
do things look like and stuff like.

Speaker 3 (26:58):
That, are your symptoms? Are you expecting some discomfort?

Speaker 6 (27:00):
Yeah?

Speaker 4 (27:01):
Exactly, exactly. There are PCR methods and things, but they're
not always available. And then treatment is hard in part
because of the toxicity of a lot of drugs that
we use and because of increasing anti fungal resistance.

Speaker 3 (27:16):
Yeah, yeah, yep.

Speaker 4 (27:20):
That's it. I could talk a little bit more about
the details of the treatment, but it's it's a little
bit boring and niche.

Speaker 3 (27:25):
So well, maybe there are times when I talk about
treatment in the history, and so maybe then we can
if they.

Speaker 4 (27:31):
Have questions, Yeah, there are gaps, So tell me hearing
about the history of this little fun guess, won't you?

Speaker 3 (27:37):
I will? I will. Modern society.

Speaker 4 (27:59):
As simple. I love when episodes start like this, Aaron,
I just love it. Keep going.

Speaker 3 (28:04):
Honestly. Sometimes I write this and then I read it
over and I'm like, why did you write this? And
it's too late. Now here we are.

Speaker 4 (28:12):
Yes, it's great, That's why I keep going.

Speaker 3 (28:15):
Modern society is blamed for a whole host of diseases
and disorders, depression and other mental health disorders, certain kinds
of cardiovascular disease, metabolic dysfunctions, even allergies and asthma. To
some extent, this is not a novel concept. The Industrial
Revolution in the nineteenth century sparked intense discussion over how

(28:37):
things like long working hours and stress, poor nutrition, lack
of sunshine, and education for women contributed to the rise
in you know, these nervous disorders like neurasthenia or hysteria.
Setting aside the problems with some of those diagnoses, especially
neurasthenia and hysteria, and whether their relationship with with modernity

(28:58):
can truly be discs as causal, I think that this
idea of diseases of modernity captures a reality that we
sometimes struggle with, and that is that progress comes at
a cost. Most of the costs that people are concerned
with are general or hard to quantify. It just as

(29:18):
like a feeling that we have. So for example, our
computers are capable of more than we could have dreamed of,
and at the same time we are more sedentary and
overconnected than we have been in you know, most of
human history, contributing to chronic and mental health conditions. Have
things improved overall thanks to computers, our computers and net

(29:41):
positive absolutely, like, there's no doubt about that. But we
can also consider the cost factored into that equation hundred percent. Yeah,
And I think that we are especially prone to thinking
that science and medicine moves in one direction, more knowledge,
more treatments and cures, better health care when it's not
being thwarted by uninformed disinformation spreadish like RFK Junior and

(30:03):
his ilk. But unfortunately, this forward progress, it's not always
the case, or at least there's a more nuanced story
to tell. Sometimes it's more of like a two steps forward,
one step back kind of a thing, and rarely are
we able to predict what that backward step might look like.
This was certainly the case with antibiotics. And no, I'm

(30:26):
not talking about antibiotic resistance. I mean people did that
is a step back, and people did see the writing
on the wall almost immediately when they came out. But
I mean Canada, Oh my gosh, I love this. Yeah.
When penicillin came onto the scene in the nineteen forties,
quickly followed by other antibiotics such as streptomycen in the
nineteen fifties. They led to a revolution in healthcare. It's

(30:49):
a powerful story that we all know well, and if
you don't, you should check out our antibiotics episodes from
years back. But the miraculous recovery of patients on the
verge of death from a bacteria infection, that's just one
of the transformations brought about by the advent of these drugs.
The other was Canada changed from a mostly benign which

(31:10):
is not to say it wasn't uncomfortable or caused issues
superficial fungal infection to a sometimes invasive systemic disease, and
ultimately it led to a few fringe doctors promoting an
unsupported hypothesis that to this day is used to sell
people's snake oil supplements that can harm much more than

(31:31):
they can heal. Oh, I'm so shocked to hear that.
I got so like, just frustrated with this episode anyway,
and that part. But before we can tell the story
of that transformation, let's first go back in time to
the early history of candidiasis. Okay, of course it's Hippocrates,

(31:54):
like it's always hypocritsial.

Speaker 4 (31:56):
I'm gonna say I was going to get a little
sad if there wasn't, because I was like, gosh, is
this only going to be a modern thing, But like, no,
it must have been around forever.

Speaker 3 (32:03):
It's been around for It's been around forever forever.

Speaker 4 (32:07):
Yeah, yeah, it's our friend. It lives with us.

Speaker 3 (32:10):
Yeah, yeah, yeah. Sometimes it's like, you know, a little
not even codependent, but just like dependent, and we're like
we little stop.

Speaker 4 (32:19):
Like yeah, stop calling me, Stop calling it's too much.

Speaker 3 (32:23):
Do not disturb mode, just like yeah, okay. Hippocrates, in
one of his classic texts, he describes thrush like oral
thrush is what I'm referring to, particularly in people who
are already sick or in poor health. Galen also made
mention of thrush, especially in sick kids. And there's a
smattering of mentions throughout the sixteen hundreds and seventeen hundreds

(32:45):
where thrush, thrush really is what predominates throughout history. And
that's understandable because yeah, yeah.

Speaker 4 (32:52):
Because it would have been there, and no one was
going to talk about vaginas of.

Speaker 3 (32:55):
Course, not yeah, no, no, but it was. Actually thrush
was recognized as relatively common in newborns, and apparently so
common in France that in seventeen eighty six, a medical
society offered a reward for its study. Oh interesting, Yeah,
outbreaks of thrush were known to happen at lying in

(33:17):
hospitals where people came to give birth and then spend
some time in recovery afterwards, and so there would be
like outbreaks throughout the hospital. And in the eighteen hundreds
is when the many faces of candidiasis or Canada began
to be noted esophageal vaginal. So the first vaginal yeast
infection was clinically described in eighteen forty nine. It's so

(33:39):
late and published in the Lancet. Yeah wow, Okay, mouth lesions,
brain lesions, even intestinal disease, even some systemic infections. But
disentangling what caused these infections was much more challenging, especially
when this yeast can overgrow or cause infections on so
many different parts on the body, in the body, everywhere,

(34:02):
or when they are like moral or ethical considerations, like
doctors were reluctant to examine women, and even when a
doctor did conduct an exam and found a yeast infection,
they were like, oh, it's just a symptom of another disease.
It's not a condition. In its own, right. Yeah, that's
so interesting, okay. I mean, but similarly oral thrush. You know,
you talked about how it can almost be like brown.

(34:22):
It was recognized or thought to be the precursor to
diphtheria in a lot of cases because that thick membrane
as well. Yeah, okay, And in some cases the infectious
nature of these lesions was suspected or like couldn't really
be ignored. It was like, well, it has to be infectious,
and in other times it was. The infectious nature was

(34:45):
proven by experimental infections, one of which at least one
of which led to an infant's death. Healthy infant. Let's
just infect a bunch of these with this and see
what happens. And one died some of that absolutely horrific,
that's horrible.

Speaker 4 (35:02):
Yeah, this was in the eighteen hundred, eighteen hundreds.

Speaker 7 (35:04):
Yeah, oh god, yep.

Speaker 3 (35:08):
And you know, I think that around this time when
germ theory rose to prominence, it reinforced this idea of
one microbe, one disease, one cause, one disease, kind of
a thing where one pathogen was responsible for one infection
in particular, which is great for diagnosis and developing treatments.

(35:32):
Or vaccines, but at the same time it made it
harder for people to realize or recognize when something didn't
fit that paradigm, such as Canada, which by this time,
let's say, by the early nineteen hundreds, went by a
million different names. And so for the full picture of
what Canada was capable of, we needed someone who was

(35:52):
able to look past the trees to see the entire forest.
And that someone turned out to be Rhoda Benham, who
later became a leader in the emerging field of medical mycology.
In a nineteen thirty one article in the Journal of
Infectious Diseases, she put forth the idea that all of
these diverse infections from mouth to vaginal to intestina, all

(36:13):
of these different things, each of which had been attributed
to different fungal species with like different names, because they
were like, oh, we isolated this from the mouth, Oh
this came from the fingernail, right, it must be this
different thing. It actually just came from one species one organism,
which at the time was Manilia alba cans later turned

(36:33):
into Canada alba cans, which also did you know means
whitening white, Like it's like.

Speaker 4 (36:39):
I did not white white, white, white, white, does tend
to have white cheesy business.

Speaker 3 (36:44):
Yeah, exactly, she wrote. Quote. If one were ignorant of
the source of these cultures, one would be unable to distinguish,
for example, m alba cans isolated from thrush, from m
silosis isolated from sprue, and it would seem necessary for
the present to regard such forms as merely strains of

(37:05):
one species.

Speaker 2 (37:06):
End quote.

Speaker 4 (37:07):
There you go in other words, like just look at it.
They're all the same.

Speaker 3 (37:11):
It's all the same. Stop calling these things different names.
It's the same thing, same thing, the same thing, which
was a pretty like novel idea, I think, for like,
the concept that this thing could be cause infections in
such diverse basically everywhere in the body. It seemed like
it's a new idea. And so at this point, let's

(37:31):
say the nineteen thirties or so, Canada had caught the
interest of a few researchers, but to be honest, it
was more of an afterthought, like not super pressing. It
was like there were a lot of other things that
people were concerned with at the time. Wasn't the hottest thing,
but the birth of the antibiotic era was about to
change all that by the nineteen fifties, antibiotics had saved

(37:54):
countless lives around the world. But the excitement that had
accompanied the emergence of this new class of drugs was
beginning to be tempered by a few unexpected consequences. New
antibiotic resistance strains causing infections that couldn't be treated, allergic reactions,
toxic side effects in some of these, and arise in Canada,

(38:15):
infections both superficial and invasive in those receiving antibiotics. And
this last observation led the Council on Pharmacy and Chemistry
of the American Medical Association to release a statement in
June of nineteen fifty one that said that bottles of
the three leading antibiotics should carry the following warning quote

(38:37):
Patients receiving these drugs may be more susceptible to manillial
or other yeast like organisms. End quote.

Speaker 4 (38:44):
Wow, yeah, way back.

Speaker 3 (38:46):
When, way back when. And it's interesting this was not
without controversy, right, because first of all, it was hard,
I think for people to draw the connection between how
were how exact actually were antibiotics causing this greater susceptibility.
And secondly, since Canada is a commensal of humans, how

(39:07):
do you distinguish between what is a harmless or a
harmful overgrowth? And thirdly, what are we supposed to do
about it?

Speaker 6 (39:14):
Right?

Speaker 3 (39:15):
Right at that time the nineteen fifty one no treatment,
But within a few years that last question what do
we do about it? Would be answered nineteen fifty four
with the first anti fungal on the market, nic statin,
which is the market name micostatin. This is developed by
Elizabeth Hazen and Rachel Brown. A few years before I

(39:35):
think it was like in production, and then by nineteen
fifty four it was on the market. Most of the
antibiotics then available were derived from fungal species, like penicillin,
which had used these compounds to compete with bacteria like
I feel like yeah, it's I just love yeah, and
so using that same logic, Nystatin was developed from a

(39:56):
bacterium Streptomyces norsea found in so oil from a friend's garden,
like one of their friend's garden, and because Hazen and
Brown reasoned that soil was this battleground for all sorts
of microbes that are all like, let's bring out the
big guns. You know what we're gonna here's this compound
for this and this compound for that, and I'm going
to outcompete you and I'm going to just destroy you.

Speaker 4 (40:18):
You got to think ecologically. I love it.

Speaker 3 (40:22):
Ecology matters, and so that's yeah, voila, there you go,
nice Seaton. And then but the other two questions, sort
of like when is Canada a problem and what why
is it doing this? Those proved a little bit more

(40:43):
challenging to answer. Clinical evidence was mounting that while antibiotics
were associated with systemic and deadly infections with Canada through
disrupting the microbiome, these weren't as common as initially thought,
and it might actually have been a company nation of
our detection methods improving for this, and so that being

(41:06):
partially responsible for the apparent rise both in systemic as
well as superficial and by superficial I mean like on
your schedule exactly infections. But the important lesson was that
antibiotics could disrupt someone's microbiome, which provided Canada an opportunity
to grow more than it ordinarily would, and that disruption

(41:28):
could happen from other things besides antibiotics, like for most people,
any yeast infection would be handled relatively simply through an
antifungal like nystatin, and then some of the later ones
that came onto the scene. But for some, such as
those who are immunocompromised, that microbial dysbiosis, regardless of whether
it was triggered by antibiotics or not, could result in

(41:50):
more invasive and difficult to treat infections, and Canada ended
up around this time, let's say, the nineteen seventies and eighties,
being labeled a quote unquote a disease of the diseased,
which is like not maybe the nicest way to put
it, it's not the best way to put it, but I
think what it does is it conveys that this was

(42:11):
an infection of disruption, something that would become even more
clear in the nineteen seventies and eighties. In these decades
with more patients than icee use, you know, as healthcare
and our ability to help people improved, overall, we had
more people who were you know, alive, can.

Speaker 4 (42:28):
Keep people alive even as they got sicker, and that
comes with its own set of problems, complications.

Speaker 3 (42:35):
And then things like organ transplant. Also, you know, people
who were on im you know, suppressive drugs to prevent rejection.
Organ transplant was a very relatively, very new thing, not
just relatively and so and then in especially in the
nineteen eighties, the rise of the HIV AIDS pandemic and candidiasis.

(42:55):
You touched on this a bit, but it was especially
a problem for people with HIV AIDS, and one estimate
suggested that by the mid nineteen eighties seventy five percent
of people with AIDS had oral candidiasis, and that of
course had the potential to become more invasive because their
immune systems were so suppressed. And fortunately by that time

(43:16):
there were newer anti fungal drugs that had come on
the scene that were usually quite effective in treating these infections,
and their development was in part motivated by the spread
of this yeast. But the increase in awareness that Canada
received during this time it also inspired a different movement,

(43:38):
one not entirely grounded in scientific evidence. Okay, In nineteen
eighty two and nineteen eighty three, two books came out
claiming that Canada was the cause of a host of
poorly understood and ill defined physical and mental health issues.
One book was titled The Missing Diagnosis by or Orient

(44:00):
Trusts and the other was The Yeast Connection, A Medical
Breakthrough by William Crook literally good Namebor Crook. I can't
believe it.

Speaker 4 (44:10):
I can't believe it. I mean, I guess you don't
have control over that, but you don't.

Speaker 3 (44:14):
Yeah, it just as it just was funny to me. Yeah.
And the overall premise of both of these books were
that many people were unknowingly living with a chronic overgrowth
of Canada, which led to an overall more suppressive state
and predisposed them to a variety of conditions ranging from
tissue injury and eucosal infections to mental health issues. A

(44:37):
self diagnosis checklist was included along with a nine step
program with also many substeps for treating this alleged overgrowth. Okay,
diagnosis was confirmed only with a positive response from the
nine step program.

Speaker 4 (44:52):
What were the nine steps?

Speaker 3 (44:53):
Were they like? Okay you that and.

Speaker 5 (44:57):
Exercise basic will make you feel better? Yes, exercise was
one of them. A diet was another. Okay, here we go,
I found it. Continuing observation in order that concomitant diseases
can be detected, accurately diagnosed, and specifically treated. Exercise program,
mental health program, avoidance of chemical pollutants, maybe there's more.

Speaker 3 (45:21):
Information in the book on that. The use of antioxidants, okay,
use of special laboratory tests like the ratio of helper
cells to suppress our cells, blood vitamin studies, mineral studies
and hair blood and urine amino acid studies in urine
essential fatty acid profile. That's step six, right, okay, okay,
special dietary program. We'll get into that in a second,

(45:44):
including supplements those.

Speaker 4 (45:46):
On here, of course, the use of to get from them, yep.

Speaker 3 (45:49):
The use of anti fungal agents for months topically and orally.
The use of allergenic extracts of Canada albacans for immunotherapy
or provocation neutralization. Okay, that's yeah, that is that's nine.

Speaker 6 (46:07):
Okay, yeah, okay, Aaron, So.

Speaker 4 (46:12):
So you do all these things at once, so you
have no idea what's helping you.

Speaker 3 (46:16):
Do all these things at once? Right right? As far
as I can tell, it's not a step wise thing. Okay, yeah, okay.
So just to give you a better sense of like
the picture of this, I'm going to quote from Trust's
Missing Diagnosis quo. This is a this is just excerpted.
There's a lot more where this comes from. Okay quote

(46:37):
depression is common, often associated with difficulty in memory, reasoning,
and concentration. These symptoms are especially severe in women, who,
in addition, have great difficulty with the explosive irritability, crying,
and loss of self confidence that are so characteristic of
abnormal function of the ovarian hormones. Poor and organ response

(46:59):
to these sex hormones is confirmed by the common association
of acne impairment or total loss of libido, and the
whole range of abnormalities of menstrual bleeding and cramps, as
well as a very high incidence of endometriosis and those
who have undergone hysterectomy. Many of these patients also start
developing multiple intolerances to foods and chemicals, making it increasingly

(47:21):
difficult for them to live in a normal environment. Many
or all of these intolerances disappear as the yeast problem
is brought under control end quote what yeah, okay, So yeah,
bringing it under control, I went through the nine steps there.
It's a lot of it's that long term, not just

(47:43):
anti fungals though also antibacterials were prescribed like antibiotics.

Speaker 4 (47:49):
What yeah, okay, mm hmmm mm hmm okay.

Speaker 3 (47:54):
Canada extracts, that one for amminotherapy and this anti the
anti Canada diet. So there's a lot to unpack here.
So first there's the vague and diverse array of symptoms
of what was termed candidiasis hypersensitivity syndrome, and then women
being called out in particular because of something about like

(48:14):
sex hormones. It was unclear to me from that what
the connection.

Speaker 4 (48:18):
Of that meant. Yeah, and like why does that have
anything to do with Canada.

Speaker 3 (48:23):
H birth control was also blamed, of.

Speaker 4 (48:26):
Course, birth control has been blamed pretty commonly. Yeah, realistically,
even if you're on an estrogen containing birth control, you're
probably having lower estrogen levels on average than you would
if you were well, certainly if you were pregnant, but
also then if you were like cycling, and so there
isn't really a good association between There is a slight
association between like menopausal hormone therapy and a slight increase

(48:47):
in use infections, but even that is not like major.

Speaker 3 (48:50):
Right, And also we're talking about yeast infections, right, vaginal
yeast infections whatever this is yeah, yeah, yeah, yeah, And
I like the other symptoms are like when I said
earlier that like these are really vague. In general, it's
things like headache and malay, so things that people do
experience right, probably regularly in association, in association with who

(49:12):
knows what, many different things.

Speaker 4 (49:14):
I mean, it just definitely feels like this is something
that's preying on people who haven't found an answer from
somewhere else.

Speaker 3 (49:19):
Literally, that's what I have done here. Yeah, we'll get there,
But I want to tell you about the diet too, because,
like I think that this is still incredibly incredibly popular.
So the diet requires strict adherents and is incredibly limiting.
So there's no sugar at all, even fruit, Like you
can't have fruit, oh my god, Okay, no pork, no gluten,

(49:39):
no popcorn, coffee, nuts, mushrooms, truffles, no alcohol. Many grains
are excluded, but fresh and organic meats and fish. But again,
no pork are allowed. Why no pork? Something about pork. Allegedly,
according to this, pork contains some sort of retroviruses that. Yeah, yeah,

(50:07):
like that retroviral something.

Speaker 4 (50:08):
So I'm not like pro probate. I love bacon, but
I know it's terrible for me, but like it's not
causing Canada.

Speaker 3 (50:15):
It's not. It's not. And these books, though, and the
idea that they promoted became wildly popular, like selling out
book prints or whatever, and leading many people to seek
months of systemic and topical antifungals from their doctor. They
discontinued birth control, and they started to take a suite

(50:37):
of supplements that were probably not great. Actually, there have
been a few cases of people who either go on
the diet or start taking these supplements that end up
putting them in a hospital, or they're on these anti
fungals for so long anyway, So this it got to
a point, it got to be such a problem that
by nineteen eighty six or in nineteen eighty six, the

(50:57):
Executive Committee of the American academ of Allergy and Immunology
released a statement listing their critique of the candidiasis hypersensitivity
syndrome and all linked to this because it has like
almost like a point by point reputation, And their ultimate
conclusion was that quote on the basis of the evidence
so far reviewed and until appropriate published evidence to the

(51:18):
contrary is brought to its attention, the Practice Standards Committee
recommends that the concept of the candidiasis hypersensitivity syndrome is unproven.

Speaker 4 (51:27):
End quote, I mean pretty straightforward.

Speaker 3 (51:30):
It didn't really do anything. Over the next decade, though,
researchers like started to look into this with carefully designed
clinical trials because they're like, if this is the thing,
this is we have a path forward.

Speaker 4 (51:42):
Right, let's figure out. Let's figure it out. So we
figured it out, treat it well.

Speaker 3 (51:47):
They tested the anti the anti Canada diet. They there
was a test or a trial with prolonged treatment with
nistatin and also looking screening for Canada throughout the body.
No strong evidence emerged for the condition. And if you
look at candida is a hypersensitivity syndrome on Google scholar,

(52:10):
you will find a few papers from the eighties and
early nineties, but anything that's more recent tends to come
from things like the Canada Clinic or like the Canda
whatever sort of Canada pro pro this idea.

Speaker 4 (52:21):
They're clearly like they have an air reviewed because they're
trying to sell you.

Speaker 3 (52:25):
A supplement, supplement or something, yeah, a book. Yeah, but
and in fact, because like one of the ideas that
they promote is that okay, you need to like for
and why the diet is there is that it cuts
down Canada in your gut and there's actually a paper
from twenty twenty two that suggests that Canada in your

(52:46):
gut is a mutualistic, beneficial back to or a beneficial
organism and it's a sign of it can be a
sign of a healthy, healthy gut.

Speaker 4 (52:56):
I mean, you want your gut micro boom to be
quite varied, Yes.

Speaker 3 (52:59):
You do, you do. But yeah, nevertheless this persisted. This
idea of Canada overgrowth or Candadias is hypersensitivity syndrome. And
you've got countless organizations, supplement companies and forums dedicated to
spreading the word. And why it has remained so popular,

(53:19):
I think comes down to two main things, and the
first is that it is what you touched on. Medicine
doesn't have all the answers, and people seeking help are
sometimes dismissed or have their questions ignored and their concerns ignored.
And I don't doubt that people who think they have
this condition or are experiencing symptoms of Candidias's overgrowth or

(53:39):
Canada overgrowth are probably experiencing uncomfortable, disruptive, or even debilitating symptoms.
But so far no evidence points towards Canada as the culprit.
Doesn't mean that someone isn't having headaches or digestive issues,
but that it's probably not Canada. And the Canada diet

(54:00):
probably helps because you're paying attention to what you're eating.
You're you're cutting out a lot of things that probably
don't make you feel great.

Speaker 6 (54:07):
Right, it would be great if we could all cut
out sugar, yes, Dice, I mean, yeah, there are great
if some at least tone it down a bit or
like some elements, but like not.

Speaker 3 (54:19):
Yeah, it's yeah, I eat so much, so many blueberries,
I know that about you. Yeah, it's one of my
absolute favorites. I mean, that's why I love Costco just
everything else, clam shells, Yeah, fistfuls of blueberries. But but
again these just because you're receiving a benefit or feel

(54:42):
better from the Canada diet doesn't mean that your Candada
levels are changing. In fact, there have been studies that
indicate that there is no change. And honestly, it would
be great if if it were Canada. Wouldn't that be
nice because there'd be Here's here's a straightforward answer. There's
probably a straightforward fix. This is what we can do.

(55:02):
People who are desperate for answers, desperate for relief, may
find themselves looking outside of medicine for someone to tell
them what's happening, which brings me to the second reason
why I think this has remained so popular. It's because
there are countless people who are happy more than willing
to profit off of it. There was one I just

(55:22):
I googled anti Candida supplements just to see what was
out there, and it's like endless options, of course, and
I just I am. I am so livid, Like livid
isn't even the right word. I'm just so exhausted by
the fact that this is a thing that is continuing
to grow and grow and grow. There was one supplement

(55:45):
business and I won't name the name of it, but
it popped up as one of the companies that's selling
these anti Canada supplements, and I looked up, Okay, what
is their net worth? What is their income? What do
they get every year? Tens of millions of dollars every
year for medicine backed quote unquote absolutely not medicine fact
cleanses that promise to restore gut health or make you

(56:08):
free from Canada.

Speaker 4 (56:10):
Aaron, I mean, it all just makes me want to
do in a whole nother supplements episode because there's still
so much more there.

Speaker 3 (56:15):
It's even like when we did that what last year?
Yeah was that last year? Already it's worse. It's worse.
It's growing and growing and growing.

Speaker 4 (56:24):
They're also I've been been looking at this ATLI. There
are so many because you said these A lot of
these people who promoted this idea back in the eighties
were physicians.

Speaker 3 (56:31):
Oh so is the person who has the supplement right.

Speaker 4 (56:35):
That is what is on the social media's right now,
which I won't call out my name, but like almost
every very prominent even physician, influencer or whatever, sells at
least one supplement or has advertised for at least one
supplement or whatever. And it just makes it like, ah,
it makes it so so so hard because you just can't.

(56:56):
And it's not like we said in our Supplements episode,
it's not like supplements are evil. It's not like are
all bad. It's just that they're completely unregulated and so
many of them are profiting off of miss and disinformation.

Speaker 3 (57:06):
I mean yeah, in terms of the morality question, I
feel like it is pretty immoral to manipulate people and
you're into them to sell to make money, to make
yourself richer.

Speaker 4 (57:20):
But I just meant, like, we do human supplements in
medicine for things.

Speaker 3 (57:24):
Yes, and we're painting with a broad brush here, but
I think that like when we're talking about someone who's
taking a supplement to reduce their Canada levels, right, absolutely.

Speaker 4 (57:33):
There's no evidence, there's no evidence.

Speaker 3 (57:36):
Yes, it's all, it's all. Yeah, it's predatory, predatory garbage.
So yes, And then I think the other issue with this. Sorry,
I didn't really mean to get this like.

Speaker 4 (57:49):
I said about it, I got you into it, so.

Speaker 3 (57:52):
But there's you know, I was also looking up. I
was just curious because especially yeast infections, I have heard
so many different home remedies, and you've got people who
are like put a clove of raw garlic cut in half,
tie it around a string, just coat it in yogurt coat,
just like shove a bunch of yogurt up your vagina.
That'll get rid of it, a jade or whatever, you know.

(58:15):
Like I'm sure that there's something on that website that
we yeah, yeah, disapprove of. But all of these things,
like they're misguided, and it is just it reveals so
much of what is wrong with expertise medicine. People being

(58:35):
missed by medicine. Yeah, and like our limited capacity to
answer all these questions. Probiotics, do they work? Maybe may
maybe not? Maybe that question we cannot answer right now.
What is even in a probiotic right? Which bacteria matter
in what quantities? Which don't matter? Each person is unique,
their microbiome is unique. I mean we don't even have like,

(58:57):
you know, thinking about this and like an actual puzzle
and you know you always put the edge pieces together first,
like we're still flipping over pieces, like we're not even close.

Speaker 4 (59:05):
So true, that's so true. We don't even know how
many puzzle pieces we're dealing with.

Speaker 3 (59:09):
Absolutely not. Could it be a one thousand piece puzzle
or like one hundred thousand.

Speaker 4 (59:13):
Yeah, that's so true.

Speaker 3 (59:17):
I think that. Yeah. I think that the fact that
the anti candida diet and these alternative approaches to treating
yeast infections, just as an example, as are as prominent
as they are, I think speaks to the failure of
medicine to adequately meet people's needs, the disgusting greed and
lack of regulation that allows people to sell snake oil

(59:39):
on the basis of fear and lies. And also I
think it shows the very human tendency to want answers
to want to take action, and Aaron, I, I'm sure
that you know things have improved or maybe there's reason
to hope good news on the horizon. Sorry to end
this so depressing.

Speaker 4 (01:00:00):
Oh that's okay. I don't know that what I'm going
to say is going to be any less depressing. But
we can get into what the landscape of Canada is
like today.

Speaker 7 (01:00:08):
Let's do it, okay.

Speaker 4 (01:00:40):
So when it comes to I'll start with invasive candidiosis
because that's obviously the most severe forms of candadiasis. We're
talking systemic infections. A Nature Reviews disease primers from twenty
twenty four reported an estimated community wide incidence rate. So
if you're just looking at general population, you might think

(01:01:01):
it's not that bad. It's around four cases per one
hundred thousand people in high income countries. Ah, not that bad.
But you would be wrong if you thought of it
that way, because this is not a disorder systemic invasive
candidiasis that is particularly prevalent amongst the general population, but

(01:01:24):
in hospitalized patients worldwide, we see about one hundred cases
per one hundred thousand hospital admissions, and in the ICU
and estimated five to seven cases per one thousand ICU
admissions in newborn babies, especially premature newborn babies. We see

(01:01:44):
twelve cases of invasive candidiasis per one hundred thousand births
of premature babies in the US.

Speaker 3 (01:01:50):
Wow.

Speaker 4 (01:01:51):
So this is a disorder, a disease that for most
people who are listening or walking around, like on your
commute to work, if you're here hearing this, you might
think it's not that common. But if you work in
a hospital, if you're unlucky enough to end up stick
in the ICU, this is a very serious and seriously
common problem. And with the rise of other strains of

(01:02:14):
Canada like Canada ORS, which was first found only in
two thousand and nine, it's a very very new, newly
identified pathogen. Yeah, this is a species that was first
identified in Japan and since two thousand and nine has
been found in more than thirty countries. It spreads really

(01:02:36):
rapidly through hospital settings, and it really rapidly gains resistance.
A lot of times, the different strains of c ORS
have resistance to begin with, but then it picks up
new resistance. So we see pan resistance, we see resistance
in c oors some strains to almost all of the
anti fungals that we use, and it's been in the

(01:02:57):
US since at least twenty thirteen, and to the CDC
in twenty twenty three, there were four five hundred and
fourteen new clinical cases of c oorus in the US
in twenty twenty three, and it's been increasing. Like when
you look at the graphs on the CDC c Oris page,
it is like whoopop, it's exponential growth right now.

Speaker 3 (01:03:16):
It is, yeah, scary because it gains a foothold I
feel like in hospital settings so easily too, where it's
just like you can't get rid of.

Speaker 4 (01:03:24):
It right right. And that's not the only species that
is of increasing concern. Canada parasylosis is a whole species
complex that is also found really commonly. It's not like
a new infection per se. But we're seeing increases in
fluconazol resistance, which is one of the main antifungals that

(01:03:47):
we use, especially for like mucocutaneous infections and things like that.
We also are seeing increasing rates of what is now
called nacacomics Glebrotis, which used to be Canada Glebrota.

Speaker 3 (01:04:00):
What rolled right off your tongue. I'm impressed.

Speaker 4 (01:04:02):
I practiced so much like every time I wrote it,
I practicing it out loud. But this we also are
seeing both increasing in distribution. It's like the second most
important species in the United States and in northwestern Europe.
But infection tends to be more severe and it rapidly
requires resistance, compared to Canada Albicans, which tends to It's

(01:04:25):
not like that you can't have resistance, but it's just
for whatever reason, not as good at acquiring resistance genes.
So there's a lot of different species that are kind
of of concern and that are on the rise. When
it comes to volvovaginal candidiasis, which we talked about already
affects seventy five percent of people with a vagina at

(01:04:47):
least once, literally so many of us. But even recurrent
volvovaginal canadiasis affects an estimated one hundred and thirty eight
million people with a vagina every year worldwide, and it's
on the rise and estimated to hit close to one
hundred and sixty million by twenty thirty.

Speaker 8 (01:05:07):
Okay, a couple questions. You said, this is four to
five times a year at least four recurrent infections a year.
Some papers call it at least three years. Okay, recurrent
infections a year, but most most of them are four.

Speaker 3 (01:05:20):
Okay. A quick question before we talk more about about
vaginal uast infections. The other species that you mentioned of Canada,
do they tend to colonize the same or like cause
infections because Alba cans Is a commensal, but these don't
seem to be commensals. They seem to be pathogenic or
are they?

Speaker 2 (01:05:39):
Yeah?

Speaker 4 (01:05:39):
So with Canada orus, it's so new that I don't
know that we know Okay, it like you know, it
wasn't ever found before, so has it been you know,
certainly it can colonize our skin. I think it's estimated
that like ten percent of people, if you just like
screen people coming into a hospital or something, that ten
percent of pe people who are colonized will go on

(01:06:01):
to develop an invasive infection. So it's not like it
causes infection in all of them. And same thing with
you know what is now not a ceomic's glebrodis and parapsylalosis.
Why is that one harder than yeah, the other one
is anything right? And there's also there's more too, right,
Like there's other candidaal or what used to be Canada
and are now you know, reclassified. So most of these

(01:06:24):
can be found on some percentage of the human population
just as commensals.

Speaker 3 (01:06:29):
But in terms of the infections that they will cause,
it's the same sort of suite of in theory.

Speaker 4 (01:06:36):
In theory, yes they could, but because I think, because
especially with c Orus, we are screening for it in
we are seeing it more as an invasive infection. Okay,
where because and what does this just come down to
the fact that Canada Albucins is still the most prevalent.
So if there's going to be an overgrowth, it's going

(01:06:58):
to win out in most case. I don't know certainly
what used to be Canada glbrata and is now not
caasaomici glbratis. It causes quite a lot of vaginal east infections,
and we see you know, parasilosis as well, So we
see all of these, but still overwhelmingly Albacans is the
most prevalent.

Speaker 3 (01:07:18):
So if recurrent east infections are on the rise, vaginal
east infections are on the rise, are they caused by
Albacans or is it one of these other species like
how much when you have a east infection. It's not
like they will necessarily culture or do they always?

Speaker 4 (01:07:35):
Not necessarily that's the problem. You don't necessarily have to
culture to get the data on what species it is.
Like where I work, we do PCRs and we can
then strain type it and species type it.

Speaker 3 (01:07:47):
But you always do strain type and species type or
that's what does happen.

Speaker 4 (01:07:50):
YEA, the PCR that at least where I work, and
this is not everywhere, but where I work, I swab
everyone if I'm worried, Yeah, try not to treat eirically.
Lots of people will just get empiric treatment. And the
PCR test that we do checks for multiple different strains,
so it's able to and multiple different species, so it's
able to tell us what that species is, which also

(01:08:11):
will give us a hint as to whether it's more
likely to be resistant. For example, if you're talking about
an invasive infection in a hospital setting, yes you're going
to be culturing that or you're going to be doing
something to figure out exactly what species we're talking about.
But for a lot of muco cutaneous infections, people might
be treated just empirically, meaning just based on clinical exam,
which I'll be honest, it's usually pretty obvious, but not always.

(01:08:34):
And the reason I always swab is because a lot
of times you've got BV and yeast overgrowth. Like it's
not only just a one thing, but a lot of
people will be treated empirically, either because they don't have
access to something like PCR, or they can't afford it
because it might be you know, cost prohibitive or a
lot like what we would do where I worked during
residency is put it under a microscope and look at

(01:08:55):
it under the swab. You know, look at the swabuder
the microscope and then you can see the hyphel growth,
but I don't know what species that is, and so
then you're at least knowing for sure that it's a
yeast infection and not a yeast plus other things, but
then you don't necessarily know what species it is. So
it totally just depends where you are and what the
healthcare infrastructure is like, and so we don't know to

(01:09:16):
answer your question of is it just mostly still sea
ambacants on the rise, but it's contributed by all of
these other species as well, and by the increasing antifungal
resistance that we see especially in these other species of Canada,
which again are on the rises in a lot of cases.

(01:09:38):
And so that is a very real and very scary
aspect of Canada right now, is just the rise in
antifungal resistance, especially when it comes to c Orius. Something
like thirteen to thirty five percent of isolates are found
to be resistant to essentially all the antifungals.

Speaker 3 (01:10:00):
That we have and we just detected this sixteen years ago.

Speaker 4 (01:10:04):
Correct.

Speaker 1 (01:10:05):
That is.

Speaker 3 (01:10:07):
Very scary. I know.

Speaker 4 (01:10:11):
There's a lot of need obviously for research in better,
more accurate and faster diagnostic tools and better treatment options.
There are some that are like being fast tracked, and
you know we're trying. There is actually a new drug
approved for I believe it's approved for recurrent volvovaginal candidiasis. Okay,
that just got approved a couple of years ago. I

(01:10:34):
guess it reduces adverse reactions compared to fluconazol, but it
doesn't necessarily help with asal resistance. Another thing that's commonly
used for volvo vaginal infections is boric acid. Boric acid
like vaginal suppositories. It's quite effective. It's like a broad
spectrum antimicrobial, and it generally is pretty safe and well tolerated,

(01:10:55):
but it's not like approved for use by the FDA.
It's also not commonly in Canada or the EU, so
it's actually really hard to get access to, like you
have to go through a compounding pharmacy or you have
to make your own suppositories. I don't really understand why,
Like I guess nobody, no pharmaceutical company has bothered to
try and make a profit off of it.

Speaker 3 (01:11:14):
Is that the answer?

Speaker 4 (01:11:14):
I don't know.

Speaker 3 (01:11:15):
Yeah, maybe it's like in public domain or whatever, like.

Speaker 4 (01:11:18):
Right, did you mean, like why can't you just get
a subpository? But I don't know.

Speaker 3 (01:11:21):
I feel like I remember and I'm probably going to
like completely butcher this recollection because my memory is not good.
But in so the last season, I did a book
Club episode on vagina obscura with Rachel Gross. She's amazing,
and in her book she talks about using a vaginal
microbiome transplant kind of like fecal transplants. Yeah for but

(01:11:46):
I don't know if it was to treat recurrent yeast
infections or like a really persist at BV. But anyway,
I loved that idea.

Speaker 4 (01:11:55):
I love all of the ideas that are looking more
at our microbiome and our microbial communities and how they interact,
because we know that that's such a big driver of
these kinds of overgrowth infections, opportunistic infections. So I don't
know a lot about that, but it's really interesting to
look into and I.

Speaker 3 (01:12:14):
Feel like we were I was a little bit like
down on probiotics or like that's maybe the impression that
I gave, and I'm I'm not, like, I think there's
a lot of potential. I just don't think we're at
the stage where we can say this will do this.

Speaker 4 (01:12:25):
No, And we're definitely not at the stage of saying
put yogurt in your vagina. This is not a medical
advice podcast, No, No, there is though. Also people are
working on a vaccine for recurrence bagelal canadiasis specifically. It's
an interesting type of vaccine because it is based on
like a Canada protein of some kind. But the idea

(01:12:47):
at least who they're targeting right now, like who they're
testing it on, is people who've had recurrent infections, so
it's kind of like to reduce the risk of recurrence
rather than just like something to give to the whole
pop or something like that. But yeah, it's really promising.
I think the last paper that I saw on it,
which might have been a year or two old, now,

(01:13:09):
they were in stage two trials, so I don't know
if they've moved further from that. And then there's also
a new type of anti fungal that was recently approved.
And the reason for invasive infections, and the reason that's
exciting is because it's a easier to administer. You don't
have to do it daily. You can do it once
weekly and you can kind of front load it, which
means because the other thing, and I didn't even get

(01:13:29):
into this because there's so many components you could talk
about when it comes to invasive candidiasis, these systemic infections,
the long term sequelae of them can be really severe,
and there's not enough research into the quality of life
effects that we see after a systemic infection, but they're
really substantial. You know, if it gets into the eye,

(01:13:52):
it can cause permanent blindness. People tend to be really
sick before they even get a fungal infection, and so
then the recovery from that, like from a prolonged hospitalization
or ICU state is really substantial. So the fact that
people are working on trying to make treatment so that
it could potentially be done more in the outpatient setting
is really really huge and important. So there's a lot

(01:14:16):
more that you can read about when we tell you
about our sources.

Speaker 3 (01:14:19):
Sources time, Okay, Okay, let's see I have several a bunch,
but I'm going to shout out too in particular. So
one is a book titled Fungal Disease in Britain and
the United States eighteen fifty to two thousand by AA
Homie and Michael war Boys. And then there was oh,

(01:14:40):
if you're interested in reading, like a paper about this
nice statin relationship and like the ant the hypersensitivity candidis
is hypersis city syndrome. There was a paper from nineteen
ninety published and I feel like it was the New
England Journal of Medicine that studied the administration of nistatin
and whether it relieved any symptoms and like anything like that,
and it's called it's by Dysmute's a randomized double blind

(01:15:04):
trial of nystatin therapy.

Speaker 6 (01:15:06):
Love it.

Speaker 4 (01:15:08):
I had a number of papers for this, one of
my favorites just for an overview of Canada was Nature
Reviews Disease Primers from twenty twenty four called Invasive Candadiasis.
I also loved a couple of papers I had about
the like Virulence, but my favorite, I think was from
the journal Virulence Who Knew in twenty twenty two titled

(01:15:29):
Pathogenesis and Virulence of Canada Albacans. And then I have
several on the introduction and emergence of some of these
other species of Canada and what used to be Canada.
And then the paper that was really great on recurrent
volvo vaginal candidiasis was called Global Burden of Recurrent volvo
vaginal Candidiasis, a systemic review in the Lancet Infectious Diseases

(01:15:51):
from twenty eighteen. But I've got more and you can
find all of them on our website. This podcast with
killya dot Com under the episode stap.

Speaker 3 (01:15:58):
You certainly can a big thing. Thank you again to
the provider of our first hand account. It really means
so much for us and other people to hear your story.
We appreciate it. Yeah, thank you.

Speaker 4 (01:16:10):
Thank you.

Speaker 3 (01:16:11):
Thank you also to Bloodmobile for providing the music for
this episode and all of our episodes.

Speaker 4 (01:16:16):
And thank you to Leanna and Tom and Brent and
Pete and Jessica and everyone else. I'd exactly write Network
for help you make this podcast and the video.

Speaker 3 (01:16:25):
Did you know we're on YouTube? Possible? And a big
thank you to our listeners, our patrons. Your support means
the world to us, like we do this for you,
and it means so much that you actually tune in
and hear what we have to say.

Speaker 4 (01:16:42):
Thank you, so, thank you.

Speaker 6 (01:16:45):
Well.

Speaker 3 (01:16:45):
Until next time, wash your hands you feel the animals.

Speaker 7 (01:17:01):
On um U