In this article, we will consider candidiasis as a condition of kapha ama, reviewing the epidemiology, diagnosis and Ayurvedic management of this common condition.
Candida is a unicellular yeast whose cells reproduce by budding. A normal flora which can under certain circumstances become an invasive pathogen, it can flourish in most environments. Candida species frequently colonize the oropharynx, skin, mucous membranes, pranavahasrotas (lower respiratory tree), annavahasrotas (gastrointestinal tract) and mutravahasrotas (genitourinary tract). Candida can be found on foods, countertops, air-conditioning vents, and floors (6).
A discussion of candidiasis leads us to larger look at considerations of the ways in which epidemiology has changed from classical times until now. Many factors pertinent to the development of Candida overgrowths are relevant to modern industrial society and were not in effect in ancient times. These factors include a diet high in refined sugar and refined flour products, antibiotic therapy, environmental stresses that weaken immunity including EMFs (1), ELF radiation (2), chemical toxins and increased background radiation; sedentary lifestyles (3), epidemic obesity (4), development of immunodeficiency diseases such as HIV, and medical use of immunosuppressant therapies including inhaled corticosteroids. All these factors play a part in the frequency with which candidal conditions are seen in a typical Ayurvedic practice setting. Patients with endocrine disorders including diabetes, hypothyroidism and adrenal insufficiency are at increased risk for Candida overgrowth (6).
The most common Candida condition is vulvovaginitis, known as a vaginal yeast infection. Three quarters of all women experience at least one vaginal yeast infection during their lifetime, with at least half of these individuals having recurrent infections (5). Oral thrush is another form of localized Candida infection found particularly after oral antibiotic use and in those with dentures and asthmatics using inhaled corticosteroids (5). Intertrigo, or skin fold infection, occurring especially in warm weather, as well a diaper rash, are commonly occurring localized skin yeast infections.
In terms of Ayurvedic pathology, the association of candidiasis with curdy white discharge, thick white plaques, and lethargy as well as the relationship to kaphic predisposing factors such as obesity, diabetes mellitus, hypothyroidism, sedentary lifestyle and consumption of sugar and starchy foods mark it out as a condition of kapha ama. Candidiasis also has a relationship to gluten sensitivity and celiac disease. Gluten is a kapha allergen, being heavy, sticky, and dense in nature. We will quote here a crucial abstract from The Lancet, a highly respected medical journal, regarding the relationship between Candida hyphal wall protein and gliadin.
Coeliac disease is a T-cell-mediated autoimmune disease of the small intestine that is induced by ingestion of gluten proteins from wheat, barley, or rye. We postulate that Candida albicans is a trigger in the onset of coeliac disease. The virulence factor of C albicans-hyphal wall protein 1 (HWP1)-contains amino acid sequences that are identical or highly homologous to known coeliac disease-related alpha-gliadin and gamma-gliadin T-cell epitopes. HWP1 is a transglutaminase substrate, and is used by C albicans to adhere to the intestinal epithelium. Furthermore, tissue transglutaminase and endomysium components could become covalently linked to the yeast. Subsequently, C albicans might function as an adjuvant that stimulates antibody formation against HWP1 and gluten, and formation of autoreactive antibodies against tissue transglutaminase and endomysium (7).
By the same token, antigliadin antibodies have been found in chronic Candida infections (8), suggesting that not only should candidiasis be considered in celiac disease but also gluten should be strictly avoided in Candida infections.
Non-local Candida infections typically begin with symptoms of mandagni and or vishamagni including slow appetite, heaviness, lethargy, slow digestion, gas and bloating, proceeding on to nausea, congestion and distention. These symptoms reflect the sanchaya and prakopa stages of samprapti. As the disease process proceeds to the prasara stage there may be sinus congestion, plugged ears, tinnitus, brain fog and water retention. Typcially, the disease process will proceed no further but may continue at this level for years on end, resulting in a sate of fatigue, lethargy and general discomfort very far from health. However, in immunocompromized patients including those on chemotherapy, corticosteroids or immunosuppressant drugs and those with HIV, candidiasis can progress to the vyakti stage with serious conditions such as candida tracheobronchitis or candida pyelonephritis and even to the bheda stage, with fever, sepsis, multi-organ failure and potential fatality (5). The latter stages of candidiasis constitute medical emergencies whereas the sanchay to prasar stage of candidiasis is often best dealt with Ayurvedically.
Some case histories are given to illustrate typical patterns seen in candidiasis:
An eighteen year old male of kapha prakruti complained of low appetite, lethargy and brain fog. He was not hungry in the morning and typically skipped breakfast. He also rarely ate lunch, although sometimes he would have a cold sandwich. Between six and nine at night he took a main meal consisting of meat, potatoes, bread and vegetables. He snacked on granola and milk later in the evening. This patient displayed a typical pattern of self-perpetuating mandagni, since his late main meal, followed by snacking, made it unlikely that he would be hungry in the morning. His tongue had a thick, greasy yellow-white coating; his nails were longitudinally ridged (typically seen in candidiasis), his vata and kapha were increased and there was a kapha spike in his rasa dhatu pulse. Many of these findings are typical of chronic gastro-intestinal candidiasis.
A thirty year old woman of vata kapha constitution had been constipated all her life. She had been placed on antibiotics many times during her childhood and suffered from recurrent vaginal yeast infections, chronic vaginal irritation, depression, brain fog and sweet cravings. Her tongue had a thick white coating, and the area below her nails was red and puffy (another typical finding in candidiasis).
A thirty three year old woman of vata-pitta prakruti had gas and chronic abdominal pain. She was allergic to wheat, dairy, nuts and eggs. She had constant post-nasal drip, low energy, fatigue and lethargy. She also had a history of severe vaginal yeast infections and currently suffered from vulvodynia, a painful condition of the vulva that may follow a long history of vaginal yeast infections (9). From age thirteen to twenty two she had used a nasal corticosteroid spray. She had ridged nails and a shaved area in the back of her tongue. She was tridoshically provoked.
A fifty nine year old professor suffered from recurrent episodes of otitis externa (infection of the external ear canal) marked by oozing, crusting and itching. These symptoms are typical of candidal otitis externa. She also bitterly complained of loudly passing gas during class, an occurrence that disturbed her professorial gravitas. She was depressed and lethargic with low motivation.
Ayurvedic treatment for Candida follows the usual pattern of ahara, vihara and aushadhya or diet, lifestyle and herbs. Diet is a key factor in successful management of candidiasis. A strict kapha-pacifying diet is needed to eliminate the Candida kapha toxins and rehabilitate agni. Sugar and refined flour products must be eliminated and the sweet taste should generally be controlled in the diet. As discussed above, a gluten-free regimen is highly beneficial for Candida infections. Experience has shown that many people with candidiasis feel best when they eliminate grains from their diet for the duration of their candidal illness. Substitutes such as quinoa, amaranth and buckwheat, which are not grains but seeds, may be used to make most recipes. For example, quinoa may be substituted for rice in kitcheri or pilau or for bulgar wheat in tabboleh. Quinoa and buckwheat pastas are available too. Another food that is very kapha provoking is cow's milk, so milk and cheese are best eliminated from the diet until the Candida overgrowth is cleared up. However, cultured milk products such as dahi and kefir have been found highly beneficial in candidiasis (10). In sensitive subjects, these products can be prepared using goat milk or even coconut milk instead of cow's milk.
For rehabilitation of agni it is important to use digestive spices in preparing the food. Many spices typically utilized in the Ayurvedic diet are also anti-candida, including turmeric, ginger, cumin, cardamom and cinnamon. Therefore, recipes and teas that employ these spices are valuable in the anti-candida regimen.
In terms of lifestyle, it is important to examine ways in which overall immunity is being lowered. Habits such as alcohol abuse, which lowers immunity while introducing more yeast into the system, need to be addressed. Overall exposure to environmental toxins can also be examined and advice given about reducing use of cell phones, microwaves and other forms of debilitating EMFs. An exercise program should be gradually introduced to enhance immunity. As well as brisk walking, surya namaskar is a great practice to strengthen ojas. Important herbs for Candida infections include neem, turmeric, Vidanga, Triphala, and above all Musta. Trikatu and hing help build healthy agni and are also antifungal.
For localized vaginal yeast infections a douche of 1 T licorice, 2 tsp. turmeric and 1t Triphala steeped in boiling water is very effective. The douche is used twice weekly during active infections and once a month as a maintenance. For localized skin infections such as intertrigo, and otitis externa, neem oil can be applied. For oral thrush, turmeric mouthwash is extremely effective.
Internally, a formula can be made that combines anti-candida herbs such as those mentioned above together with the indicated dosha pratyanika herb for the individual. Alternatively or additionally, Paracleanse can be given. Because Candida is an overgrowth rather than an infection, the organisms may be present in massive amounts and hence there may be significant die-off reactions when herbal treatment is given. Symptoms of die-off reactions may include fatigue, body aches, flu like symptoms, ringing in the ears and similar indications of toxins in rasa dhatu. Sat isabgol is helpful for such reactions as it has an ability to pull toxins out of the digestive tract. Typically, anti-candida treatments should be continued for three months, after which pancha karma and rejuvenation can be done. At this point the diet will typically become less exacting and the patient's life will gradually return to normal. All that has been internalised in terms of Ayurvedic diet and lifestyle during the months of treatment will serve to prevent relapses into future outbreaks by eliminating the causes of the condition.
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Yolanda Hidalgo Garcia, M.D., Santiago Gómez Díez, M.D.,et al, Antigliadin Antibodies Associated with Chronic Mucocutaneous Candidiasis Pediatric Dermatology Volume 19 Issue 5, Pages 415 - 418
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Alakananda Ma M.B., B.S. (Lond.) is an Ayurvedic Doctor (NAMA) and graduate of a top London medical school. She is co-founder of Alandi Ayurveda Clinic and Alandi Ayurveda Gurukula in Boulder Colorado, as well as a spiritual mother, teacher, flower essence maker and storyteller. Alakananda is a well known and highly respected practitioner in the Ayurveda community both nationally and internationally.
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