The most common treatment offered by GPs and in a hospital-setting are antifungals, which generally comprise of polyene antimycotics (primarily nystatin), azoles (such as fluconazole) and echinocandins (including caspofungin). They have all displayed varying levels of effectiveness in eradicating superficial and systemic candida infection and so, identifying alternatives to this conventional medicated approach have also been investigated.
Both Saccharomyces boulardii and certain Lactobacillus strains are probiotics that have also exhibited efficacy in the treatment of candidiasis in randomised control trials (Matsubara et al, 2016; Murzyn et al, 2010; Krasowska et al, 2009). The mechanism of action by which Saccharomyces boulardii works in this capacity, is by inhibiting adhesion and filamentation of Candida albicans and thus stifling its proliferation (Murzyn et al, 2010; Krasowska et al, 2009). In terms of the specific strains of lactobacillus, they have been shown to enhance the effectiveness of the antifungal fluconazole, when used as an adjunct to address candida infection, although the mechanisms responsible are still yet to be elucidated (Matsubara et al, 2016; Marinez et al, 2009).
In addition to these specific probiotics, grapefruit seed extract (Tsutsumi-Arai et al, 2019) and oregano oil (Manohar et al, 2001) have also demonstrated the ability to tackle Candida albicans infection. This is most likely as a result of their phenolic acid content, as these compounds have been shown to exhibit antifungal properties, due to their anti-adhesion and anti-biofilm effects. Takahasi et al (2012) also found that the medium chain fatty acids caprylic acid, capric acid, caproic acid, and lauric acid inhibit candida hyphae growth, with the former two being especially effective at very low concentrations. In fact, the medium chain fatty acid composition of coconut oil has also been identified as the reason that it demonstrates an ability to reduce gastrointestinal colonisation of Candida albicans through this same mechanism (Gunsalus et al, 2015).
Preliminary studies on the anti-candida effects of spirulina extract and fresh garlic extract have also shown promising results in vitro and may be an area of future research, thus adding to the potential effective natural treatment options (Shuford et al, 2005; Marangoni et al, 2017). From a general nutritional perspective, dietary carbohydrate has been shown to modulate biofilm development, with increased glucose intake specifically, promoting a greater susceptibility to candidiasis (Vargas et al, 1993; Santana et al, 2013). Consequently, a reduction in carbohydrate consumption (especially simple sugars and refined carbohydrates) can be useful for individuals with candidiasis and is thus, commonly advised by nutritional practitioners when addressing candida infection.
Although research has demonstrated the individual efficacy of the numerous treatment options currently available to successfully address candidiasis, none of them when applied as a monotherapy, have proved successful in 100% of cases. As a result, for individuals with a candida infection, employing a combination of the interventions discussed in this article, in addition to appropriate lifestyle changes to minimise stress, improve sleep quality and boost immunity, may indeed be the most prudent and effective approach to successfully treating this condition.
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