A recent study published in the journal PLoS Biology has found that Candida albicans forms two distinct biofilm types according to what form the Candida is in—the sexual or asexual form.¹ A biofilm is a protective polysaccharide matrix in which microbial populations exist and are able to hide from the immune system and antimicrobials. As it turns out, when Candida is in an asexual form, it produces a biofilm that is impermeable to antifungals, antibodies and white blood cells. This asexual form makes up the majority—about 90 percent—of Candida cells in the body. The other ten percent are sexually reproducing Candida cells that form a similar looking biofilm that behaves differently and is susceptible to antifungals and to the immune system.

Biofilms are formed by more than just Candida, however. The National Institutes of Health (NIH) estimates that nearly 80 percent of chronic microbial infections are due to biofilms.² Dr. Maria Usman, MD has developed, and is refining, a Biofilm Protocol for use in children with gut disorders on the autism spectrum.³ She is seeing some success with this protocol, though it must be tailored to the individual and can cause a “die-off” reaction, also known as the Herxheimer reaction. (When microbes are killed they give off microbial toxins that can cause sickness-like symptoms that can make the patient feel worse before getting better.)

Another approach that can help get Candida and gut issues under control is the 4R Model.⁴ The Institute of Functional Medicine promotes this model as the best way to evaluate and treat patients with gastrointestinal complaints. The 4R model asks four main questions:

REMOVE—What may need to be removed? This may be pathogenic or potentially pathogenic organisms like Candida, bacteria or parasites. It can also be foods or toxins to which the person is sensitive or allergic.

REPLACE—What may need to be replaced? In this step, the use of digestive enzymes and HCl should be considered to ensure that they body is properly absorbing necessary nutrients.

REINOCULATE—What may the body need to be reinoculated with? This considers intestinal microbes and uses probiotics and prebiotics to reestablish intestinal balance.

REPAIR—What may be needed to repair a healthy mucosal layer? The use of certain nutrients, such as L-glutamine, to repair the mucosal layer are useful here. 

One probiotic—the probiotic yeast Saccharomyces boulardii—may be particularly helpful for those with Candida problems. Candida often occurs in people who have been treated with antibiotics. Antibiotics target bacteria, both good and bad, but do not affect Candida because it is a yeast, leaving no competition for Candida. This is where S. boulardii can be helpful, because it is not killed by antibiotics like other probiotic bacteria. Futher, S. boulardii has also been shown to inhibit Candida albicans.⁵ S. boulardii produces capric acid, and both have been shown to downregulate (reduce) the expression of genes associated with Candida virulence. Thus, the capric acid secreted by S. boulardii inhibits C. albicans hyphal formation, adhesion properties and biofilm formation.⁶ Probiotic bacteria have also been found to be helpful for Candida by helping to reduce and inhibit Candida, and by stimulating immune response against Candida.⁷ 

Bringing the gut back into balance takes a multipronged approach.  The 4R program can help address the multiple issues that arise when faced with digestive conditions like Candida overgrowth. 

1. Song Y, et al., “Alternative mating type configurations of Candida albicans result in alternative biofilms regulated by different pathways.” PLoS Biology. Aug 2011;9(8): e1001117.
2.  http://grants.nih.gov/grants/guide/pa-files/PA-03-047.html
3. http://www.autismpedia.org/wiki/index.php?title=Protocols/Usman
4. Jones DS (editor), Textbook of Functional Medicine, The Institute for Functional Medicine, 2005, p. 462-8.
5. Krasowska A, et al., “The antagonistic effect of Saccharomyces boulardii on Candida albicans filamentation, adhesion and biofilm formation.”FEMS Yeast Res. 2009 Dec;9(8):1312-21.
6. Murzyn A, et al., “Capric acid secreted by S. boulardii inhibits C. albicans filamentous growth, adhesion and biofilm formation.” PLoS One. 2010 Aug 10;5(8):e12050.
7. Wagner RD, et al., “Biotherapeutic effects of probiotic cacteria on candidiasis in immunodeficient mice.” Infect and Immun. 1997 Oct; p. 4165-72.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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It’s a subject you’ve heard me talk about before, but considering new research it’s definitely worth repeating. A recent CBS news segment revealed that not one but five new studies showed that using acid-blocking drugs called proton pump inhibitors (PPIs) can be potentially dangerous to your health, and that “more than half of prescriptions for these drugs are unnecessary”. Folks, this is an eye-opener if there ever was one!

Every year more than 100 million Americans are prescribed PPIs to help relieve symptoms of heartburn and acid reflux, but what many people don’t know is that these drugs often come with some pretty serious side effects—including a nearly 75 percent greater risk of developing a severe intestinal infection known as C. diff, according to new evidence. Essentially, taking PPIs upsets the healthy bacterial balance in your intestines (which is where the majority of your natural immune defenses can be found), leaving your body vulnerable to illness and infection.

Widespread PPI use has also been linked to higher rates of pneumonia, as well as esophageal candidiasis (yeast overgrowth), inflammation of the stomach lining, increased permeability of upper GI tract lining, and even osteoporosis-related bone fractures due to the fact that PPIs block calcium absorption in the body. Because long-term PPI use also leads to hypochlorhydria (low stomach acid secretion), bacterial overgrowth and acetaldehyde production, PPI users have an increased risk of developing gastric cancer. 

The good news? There are simple things we can do every day to help prevent heartburn and acid reflux without relying on harmful drugs. Diet changes like limiting our intake of caffeine, alcohol, chocolate and fatty or spicy foods can make a big difference, along with maintaining a healthy body weight, getting plenty of exercise and quitting smoking—all pretty good advice if you ask me! Natural supplements made with ingredients such as ellagic acid (from raspberries and pomegranates) can also provide soothing relief for occasional heartburn, and digestive enzymes with added HCl can help ensure complete digestion and reduce the chances of heartburn and acid reflux happening in the first place.

The bottom line is this: why take a potentially dangerous drug when smarter, safer alternatives exist? My hope is that the more people learn about PPIs and their side effects—including why they may not even need them in the first place—the more people will take steps to improve their digestive health naturally.

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