If you’ve spent more than, like, 10 minutes on the internet, you’ve probably heard a decent amount about candida. In some corners of the internet, candida is a bogeyman blamed for everything from fatigue to brain fog. But in reality, candida is just a fungus among us. “Candida is a type of yeast that lives in our bodies and environment,” says Laura Purdy, MD, a board-certified family medicine physician. “Whether we realize it or not, it’s a part of our life every day.”
Some candida is normal, but the internet isn’t completely off base. Too much can definitely be a problem. That garden-variety yeast infection or super-itchy spot beneath your bra? It very well may stem from candida overgrowth, which is incredibly frustrating for anyone who’s tried to get it under control. The sorta-good news? Candida overgrowth is very common, so doctors are familiar with treating it.
“There are some really clear, obvious ways that candida can manifest in different parts of your body,” Dr. Purdy says. “In people who aren’t immune-compromised and are otherwise pretty healthy, candida usually grows in dark, moist, warm places.” The vagina is one of those places, which is why candida causes so many itchy yeast infections. But other areas—beneath the breasts, in the groin, or in the mouth—are also susceptible to candida overgrowth.
To complicate matters, certain behaviors and conditions can increase the risk of candida overgrowth. Taking antibiotics, for example, or using asthma inhalers daily, can leave the body more susceptible to candida overgrowth. “Your body is supposed to resist it growing, so that it doesn’t get to the point where it causes you symptoms.”
Testing for candida isn’t always necessary, as in some cases, the culprit is obviously candida overgrowth. “If I see thrush, which is the term that we use for Candida overgrowth in the mouth or the esophagus, 99% of the time, with a few rare things considered, I know what that is,” Dr. Purdy says. The same goes for beneath the breast, an area where candida is often misdiagnosed as an allergic reaction to fabric softener. In those cases, she doesn’t wait for a lab test.
But vaginal symptoms are a bit more tricky, Dr. Purdy notes. “Beyond candida, there are so many infections and co-infections that can go wrong with vaginas.” That’s why she recommends seeing a doctor if you’re experiencing vaginal itching or discharge; it might be a yeast infection, but it could be another issue.
When it comes to treating candida overgrowth, Dr. Purdy says the approach depends on the person and the severity of the symptoms. Doctors typically address thrush and vaginal yeast infections with an antifungal medicine, typically fluconazole. Among people whose immune systems are compromised—for instance, a person undergoing chemotherapy—IV treatment is an option. But, as anyone with a recurring vaginal yeast infection knows, keeping candida at bay can be difficult. “There and on skin under the breast, it’s really hard to make that less of an optimum environment for candida to to grow,” Dr. Purdy says. “We can put powder and cream and take pills all day long, but it’s still dark, moist, wet—and exactly where the fungus wants to live.”
As for prevention, Dr. Purdy says that reducing your sugar intake can create an environment less hospitable to candida overgrowth. “The type of sugary environment that the candida is exposed to has more to do with what’s going on in your blood, and less to do with what’s going on in your stomach,” she says. She cites cases of candida-driven urinary tract infections among people who have diabetes, cautioning that people who are pre-diabetic are also more likely to encounter candida overgrowth. “People who are starting to have higher blood sugar are more predisposed to candida because it’s a sweeter, more sugary, acidic environment,” she says. “Blood that has higher sugar in it is more acidic, and candida yeast thrives in that environment.”
Another way to keep candida in check? Make some lifestyle shifts. “It’s about choosing a lifestyle of wellness,” Dr. Purdy says. “I think the four components of wellness would be exercise—whatever that means for you—diet, sleep, and stress [management]. Optimizing all four of those can make the physiologic conditions less optimal for candida to decide that it wants to grow anywhere.”
As for mail-order stool-sample tests that check for candida, Dr. Purdy says to skip them. “Candida lives in the GI tract, so if we tested every person in the world’s GI tract, probably most of them are going to have candida,” she says. “Just because you go looking for something and you find candida in the stool, for example, it doesn’t mean that it’s causing the problems that you’re having … It serves a purpose. We have bacteria and yeast in our gut, and those organisms live there for a reason.” Instead, she advises scheduling an appointment with your MD (and, she says, a functional medicine doctor if you like) to understand the problem. It might be candida overgrowth, but it might be something completely different. Either way, this is another situation where Dr. Google doesn’t have all the answers.
Photo: Polina Zimmerman/Pexels