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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Notable News

Clostridium difficile (C. diff) – More than Difficult!  Chances are you’ve probably heard of C. diff before, or at least its most common (and least pleasant) side effect – the gut-wrenching diarrhea. I know, I know, here I go talking about poop again, but this is important! C. diff infections are becoming more common every year. Studies tell us that 7,000 people are infected each day, and 300 of those die from the infection. So I say the more we know about C. diff, the better.

Okay, let’s start with the basics – just what is C. diff anyway? It’s short for Clostridium difficile, a disease-causing bacterium that most often appears after a person has taken antibiotics. This happens because the good bacteria that are normally present in the intestines (and which help keep our immunity strong) are also destroyed by antibiotics. Basically, when we take antibiotics to fight infection, they kill a lot of the good bacteria in our gut along with the bad, which disrupts our normally healthy intestinal balance. And C. diff is one of those opportunistic little buggers that will quickly take over and multiply if it has the chance, causing a potentially dangerous infection whose symptoms include severe diarrhea, abdominal cramping and nausea.

Interestingly, another culprit in the C. diff epidemic has come to light. The use of proton pump inhibitors (PPIs) has been associated with a risk for C. diff infection.  PPIs are used to treat gastroesophageal reflux disease (GERD), also known as acid reflux. These drugs suppress the secretion of acid in the stomach. 

But Wait! We Need Our Stomach Acid!  One of the functions of stomach acid is to kill bacteria that comes in with food. When there is not enough stomach acid, as occurs in people taking PPIs, harmful bacteria like C. diff can enter the intestinal tract and quickly multiply.

Can You Say Superbug? Have you heard the term Superbug?  C. diff is a Superbug. Superbugs are bacteria that become resistant to antibiotic treatment, which means that after a while, taking antibiotics won’t do anything to stop the harmful effects of the bug. Antibiotic resistance is largely the result of over-prescribing antibiotics for every little sneeze or sniffle instead of giving the body a chance to fight off the infection on its own, and it’s become a huge concern in the medical community today. I’ll talk about this more in a later post, so stay tuned!

Bottom Line? Our intestinal flora – the friendly bacteria in our intestines – play a major role in our health. One particular probiotic called Saccharomyces boulardii has been found to be especially useful for people with C. diff, particularly those that have recurrent C. diff infections. The reason is because S. boulardii is actually a yeast organism, so it’s not destroyed by antibiotics like most bacteria, which means it can keep working in the body to protect against C. diff – even if you’re taking antibiotics. The bottom line is, maintaining a good balance of beneficial microorganisms (probiotics) in the gut is a vital part of creating digestive health, which as we all know is the foundation for total-body health!

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antibiotics, bacteriology, Clostridium difficile, dangerous infection, Diarrhea, diff infection, diff infections, digestive system, food, Gastroenterology, gastroesophageal reflux disease, GERD, Gut flora, Health_Medical_Pharma, microbiology, nausea, Probiotic, Saccharomyces boulardii