Ask Dr. Brad
Question: Looking at my tongue lately, it has a white coat to it. Could this be thrush? If so, what can I do about it?
Answer: Thrush, the common term for Candida albicans in the mouth, is a fungus that presents when our immune system is weakened. When healthy, we have approximately 400 different kinds of bacteria living in balance in the digestive tract. When this balance is disrupted, one or several organisms, such as Candida, will increase (overgrow) and symptoms will develop. Typically, thrush presents as white, cottage-cheese-looking patches on the tongue, sides of the mouth, or the back of the throat. A simple white coat to the tongue is not necessarily thrush, so contact your doctor before seeking treatment.
As the immune system continues to weaken and CD4 cell counts drop, many patients take antibiotics to prevent opportunistic infections. Both Bactrim and Dapsone, taken to prevent pneumocystis pneumonia (PCP), can disrupt the normal bacteria balance in the digestive tract. When this happens, Candida overpopulates not only in the mouth, but in the intestines as well. Fortunately, multiple options for the treatment of the thrush exist, with the most fundamental being dietary.
The first and foremost nutritional suggestion is the complete avoidance of sugar and alcohol. Candida's main source of food is sugar, and alcohol contains a great deal of simple sugars. While some naturopaths stress the avoidance of all forms of fruit in the sugar-free diet, I reserve that strict recommendation for cases of severe thrush. Eating the entire fruit or vegetable provides you with fiber that can minimize sugar's effect on Candida. For those with severe thrush, for instance, when it spreads into esophagus, all fruit and vegetables should be avoided.
For most cases, however, I recommend avoiding the following: fruit and vegetable juices, jellies and preserves, sodas, honey, molasses, or brown rice and maple syrup. Concentrate your diet on whole, unrefined, and unprocessed food sources of protein and complex carbohydrates. The protein category includes lean meats (beef, lamb, venison), poultry (chicken and turkey), fish, eggs, tofu, beans and legumes. Since the majority of my HIV-positive patients on antiretrovirals tend to be allergic to milk products, I suggest people avoid dairy, especially because milk, yogurts, and cheeses contain sugars that are fuel for Candida. Acceptable forms of complex carbohydrates are whole grains, again an issue over which doctors will dispute. Since carbohydrates are broken down in the gut into sugar, several physicians and nutritionists suggest avoiding these as well. Clinically, I have seen improvement in thrush even when patients consume whole, cooked grains, such as rice, millet, or quinoa, and avoid processed carbohydrates, such as breads, pastas, crackers or cereals. Whole, cooked vegetables are also included in the complex carbohydrate category. Once more, I reserve the suggestion of total avoidance of complex carbohydrates for severe Candidial infection.
The best food item you can consume if you suffer from thrush is garlic (for issues regarding garlic and antiretroviral medications see the Ask Dr. Brad column in the previous issue of the STEP Perspective). One of garlic's many healing properties is its ability to kill funguses, bacteria, and other microorganisms. The best form is raw garlic. The active part of garlic is the allicin, or the odor-producing portion. Unfortunately, garlic must be macerated or chopped in order for it to be active, so swallowing a clove of garlic whole provides little benefit. Furthermore, cooking garlic causes allicin to become less potent. I recommend one clove of crushed garlic mixed with a tablespoon of an essential fatty acid, such as flax seed oil, one to two times a day. If swallowing raw garlic with olive or flax seed oil alone is not palatable, try making a salad dressing with oil, vinegar, and one clove of crushed garlic. Or try adding one clove of crushed garlic for taste to your vegetables, grains, or protein after they are done cooking.
Since thrush develops from an unbalanced bacteria ratio, supplementing with healthy microorganisms is beneficial. The Lactobacillus species (L. acidophilus, found primarily in the small intestines, and L. bacillus, found primarily in the colon) facilitate digestion of carbohydrates in the gut, and as a byproduct of this process, they produce lactic acid. Lactic acid is unfavorable to many forms of yeast and bacteria like Candida albicans. Lactobacillus species also help keep the balance of organisms in the gut in check through the production of antibiotics (acidophilin, lactocidin, and acidolin) that prevent toxic bacterial organisms (E. coli, Helicobacter pylori, and clostridia, etc.) from seeding the gastrointestinal tract. In addition to these properties, Lactobacillus helps synthesize B vitamins and butyric acid (an essential fuel source and healer for the cells that line the colon), improves lactose digestion and absorption, and helps maintain normal bowel functioning by reducing diarrhea, constipation, gas, bloating, etc.
Regarding supplementing with Lactobacillus, I always recommend a dairy-free (avoid acidophilus-enriched milk), wheat-free, refrigerated, powdered or liquid form of acidophilus to be mixed with water (no juice due to the sugar content) and taken on an empty stomach 1 hour before eating or 2 hours after eating.
Another organism that has been used for the treatment of thrush is the yeast called Sacchromyces boulardii. Unlike Candida, Sacchromyces is a non-pathogenic (friendly) yeast. Like Lactobacillus, it, too, helps rebalance the organisms in the gut flora, but is not destroyed by antibiotics as Lactobacillus will be. Sacchromyces comes in capsule forms and should be taken like acidophilus, on an empty stomach. If you are currently on antibiotics, the recommendation is to take either or both Lactobacillus or Sacchromyces daily. If you are suffering from thrush and aren't taking antibiotics, continue with supplementation for at least a month after the thrush clears. I recommend that patients with recurrent thrush continue preventive treatment with Lactobacillus or Sacchromyces at least three times a week as a precautionary measure.
Finally, oregano oil has been found to kill many pathogenic yeasts like Candida. Encapsulated oregano oil taken three times daily has been quite successful in the treatment of mild to severe thrush when taken in conjunction with the above measure.
Brad S. Lichtenstein, N.D. is licensed naturopathic physician, personal trainer, and yoga and meditation teacher. In private practice, he specializes in HIV care, counseling, and yoga therapy. Brad works with people interested in taking an active role in their lives and looking beyond their diagnosis and illness in order to create meaning purpose in their lives. Brad continues to offer meditation, yoga and movement classes as well as offering workshops on naturopathic approaches to living well with HIV and AIDS. He can be reached at (206) 545-7133 or at his Web site at www.naturopathiclifecoach.com.
This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Perspective.