**6.** *Candida* **elimination diet therapy**

An important point is the amount of fungi found in the intestine. Antibiotic treatments are damaging the natural intestinal flora, and fungi such as *Candida* spread because important physiological germs are lacking as opponents [74]*.* Treatments such as antibody therapies or enteral nutrition can reduce the inflammation, and gut microbiota is improved.

A dietary formula for 1 week lacking fiber reduced the populations of fungi [75]*.* Therefore, it is believed that the gastrointestinal environment can be restored by a proper defined nutrition diet formula [76–78]*.*

Such diets are high in sugar and total carbohydrates which are correlated with increased methanogen *Methanobrevibacter* and fungus *Candida* and other genera from different domains of life that are negatively associated with the consumption of fatty acids, protein, and amino acids [79]*.*

*Candida* is the predominant fungal species capable of colonizing the gut and can vary extensively in time in response to recent carbohydrate consumption, antibiotic use, and environmental sources. Bacterial population structure primarily associates with long-term diet [80]*.* In a recent study, *Candida* correlated positively with long-term intake of total carbohydrates and sugar and had a strong association with recent carbohydrate intake.

Short-chain fatty acids (SCFAs) have been shown to exert fungistatic effect. Anaerobic intestinal microbiota, such as lactic acid bacteria (LAB) as a member of normal flora, produces from dietary fibers via fermentation of beneficial metabolites, and the major end products are SCFAs. Not only for the intestinal microbiota, SCFAs represent an energy substrate but for host cells as well. Their important role in reducing the development of gastrointestinal disorders, among others, is wellknown, preventing overgrowth of *Candida* [81]*.*

The probiotic strain *L. rhamnosus* GG offers benefit human health, and is a commonly used probiotic strain with immunomodulatory effect and bears an exopolysaccharide interfering with *Candida* growth and invasion tested in a model of gastrointestinal candidiasis, mostly attributed to *C. albicans* [82]*.* SCFAs have an effect on morphogenesis and therefore may provide a mechanism by which LAB could prevent candidal colonization. The growth rates are crucial for fungal growth in medium containing the disaccharide maltose as a sole nutrient source [74, 81]*.*

*The Influence of* Candida *spp. in Intestinal Microbiota; Diet Therapy, the Emerging Conditions… DOI: http://dx.doi.org/10.5772/intechopen.92791*

In a clinical study performed in individuals with chronic intestinal *Candida* overgrowth receiving nystatin alone and following a diet therapy (avoiding foods high in simple sugars and starch), different cured rates have been achieved during the 3 months of tests, 42% compared to 85% [21].

The yeasts metabolize a part of the carbohydrates from food, producing carbon dioxide and fusel alcohols. The gas causes an abdominal distension, bloating, and abdominal pain. Prolonged exposure to fusel alcohols for weeks and months can damage the liver. It was only this spring that a special toxin produced by the *Candida* yeast was found, which is responsible for many of the effects on other parts of the body. There is still a lot of research to be done in this area.

Most of the usual antifungal diets are based on the elimination of sugar and other carbohydrates and can actually relieve bloating and other irritable bowel symptoms in some patients (with or without fungal overgrowth) [83, 84]. Practitioners of alternative medicine often claim that candidiasis—the most common cause of yeast infections (vaginal candidiasis) and oral thrush (oral candidiasis)—can be treated or prevented with diet and food supplements [11]. Despite a lack of clinical evidence, *Candida* diets have become incredibly popular in recent years, mostly among women with recurrent yeast infections.

The effect is probably based on a combination of different changes at the level of bacterial flora, the formation and transport mechanisms of intestinal gas, and the osmotic properties of the intestinal contents. The concept of the *Candida* diet is that *Candida* uses sugar compounds (carbohydrates) to extract energy from them. If these sugar compounds are no longer available through the diet, the *Candida* can be "starved" in this way [85].

The *Candida* yeasts break down carbohydrates from food into carbon dioxide and fusel alcohols. The gas causes a bloated stomach, a feeling of fullness, and pain in the intestinal area. If the exposure to fusel alcohols lasts longer, they can damage the liver. The *Candida* yeast produces a special toxin that has only recently been identified and can trigger symptoms such as migraines or joint illnesses [86].

A consistent antifungal diet of at least 5–6 weeks is also essential. It is important to deprive the yeast of their base food. Sugar, sweets, white flour products, and alcohol should be strictly avoided. Sweet fruit should also be avoided in the first 4 weeks. The focus is on a wholesome diet with lots of lettuce, vegetables, and whole grain products. The high-fiber diet not only strengthens the immune system but also presumably exerts a mechanical cleaning effect by sweeping the fungal nests out of the villi through its fibrous structure and at the same time stimulating the bowel movement [87, 88]. High-content phytochemicals with an antimicrobial effect make the whole-food diet the ideal antifungal diet—however, success is only permanent if there is a consequent change in diet.

Whole foods are the best way to prevent yeast infections. The yeasts will not find the right breeding ground in the organism of a healthy person. If there is already an infection, targeted therapy and a long-term change in eating habits to a healthy, natural diet are effective remedies.

In microbiological therapy, the focus is on strengthening the immune system [89]. Bacteria are extremely important for an intact immune system. An estimated 100 trillion bacteria live in the intestine, many of which are not yet known. It is now known that these bacteria have important functions for the immune system and are not simply there by accident. Experience after lengthy antibiotic administration speaks about, again and again, weaknesses in the body's defenses which are observed because these active ingredients not only destroy unwanted but also desired bacteria. In our environment, which is enlivened by countless germs, the animals die of fatal infections after a few days because their defense system is

practically inadequate. The contact with bacteria is very important for the development of the immune system. This effect is mimicked with microbiological therapy. The patients are given probiotics and auto-vaccines for 3–6 months. Probiotics are preparations from intestinal germs that regulate the immune system. Several studies suggested that certain *Lactobacillus* probiotic strains enhance the effect of antifungal drugs (like fluconazole) used to treat yeast infections. However, there was no evidence that the strains could achieve the same effect on their own [90–95].

The use of probiotics in treating yeast infections is controversial. Although probiotics work by increasing bacteria beneficial to the vagina and gastrointestinal tract, their ability to prevent or treat candidiasis is a subject to debate. While many studies suggest that a daily probiotic can "slightly improve" imbalances that lead to yeast infections, others do not [96].

With these foods too, some of the bacteria will certainly live in the intestine. It is probably not possible to permanently colonize these bacteria in the intestine. However, a distinction must be made between probiotic medication and food. Special foods, such as yogurt preparations, cannot be used to inject as many bacteria as with medication. Patients would have to eat tons of yogurts in order to achieve a therapeutically effective number of bacteria. Then, however, they would have problems with the masses of animal protein again.

To permanently eliminate the yeast, a change in eating habits is crucial. The yeast must be deprived of their food base. It is very important to avoid sugar. In the acute diet phase of 4 weeks, patients even have to do without sweet fruits because *Candida* can also utilize fructose. Only sour apples, lemons, and grapefruit are allowed. The focus is on a high-fiber diet, which means a lot of salad and vegetables as well as whole grains [97, 98]. Their fiber exerts a mechanical "cleaning effect" by sweeping out the fungal nests between the villi, and they stimulate the movement of the intestine. In addition, fiber is cheap because it cannot be broken down by the yeast in the intestine. We therefore recommend our patients to eat whole foods.

The complex carbohydrates and especially the fiber are digested in the lower intestinal sections. However, the yeasts mainly colonize the upper sections because they require oxygen. Only relatively few yeasts can survive in the colon. Only an insignificant part of the yeast uses the complex carbohydrates and fiber [99].

The die-off effects (*Candida* dies) can be strong, especially at the beginning of treatment when a large amount of *Candida* fungi dies at once. Likely massive adrenal fatigue can be experienced during this period. In this case, the recommendation is to take a couple of weeks off not to add any new foods to diet. Die-off is usually a problem from the beginning to about the middle of treatment. As healing progresses, the die-off symptoms (like the other *Candida* symptoms) will occur less frequently and at greater intervals. Therefore, at the same time with the diet, it is highly recommended to start with antifungals and probiotics. The combination of these two kills the *Candida* yeast in the intestine and immediately populates it with "good bacteria."

An antifungal diet always represents an individual nutritional concept, which in general is based on the results of laboratory analysis. In the case of a stronger fungal attack, an antifungal medication is recommended. The microbiological therapy is often useful, since the intestinal flora is usually affected; otherwise the fungi would not have been able to multiply.

Candidiasis affecting the whole organism is fatal in about 70% of cases. The problem is *Candida*-induced sepsis, in which the pathogens can be found in large numbers in the blood. Around 40,000 people in Germany are affected by this invasive *Candida* infection every year. When it comes to hospital infections, it represents number 4 on the list of the most dangerous pathogens [100].

*The Influence of* Candida *spp. in Intestinal Microbiota; Diet Therapy, the Emerging Conditions… DOI: http://dx.doi.org/10.5772/intechopen.92791*
