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Probiotics and Candida Infections
Introduction
The yeast Candida albicans is present on or in most humans as a harmless commensal
organism. Thousands of yeast cells can be present in an individual, mostly in the
gastrointestinal tract, without any ill effect. However Candida albicans is also the major
fungal pathogen of humans. Infections can be localised, occurring in areas such as the
vagina or the mouth, both of which cause a considerable degree of discomfort. Candida
albicans can spread from a local infection to one affecting almost any organ system.
Candidiasis can be associated with or a predisposing factor for, a number of conditions
including; chronic fatigue syndrome, arthritis, irritable bowel syndrome and allergies.
Microflora
During the natural birthing process, the babies gut becomes colonized by many bacteria
common to that of their mother, as the bacteria are initially ingested from the vagina
during delivery. In turn the vaginal microflora is typically colonised with normal fecal
flora. Pathogens also colonise the vagina by ascending from the rectum and can then
move to the bladder. This process is mediated by bacterial adherence but is not a
hygiene issue. Indeed, the fact that the normal vaginal microflora also colonises from an
intestinal origin, means that microbial ascension per se is a natural process that can
actually help protect the host. Probiotic bacteria which are taken orally will colonise the
vagina in the same way. A trial using Lactobacillus rhamnosus and Lactobacillus
fermentum were recovered from the vaginas of women given the probiotic strains in a
milk drink.(10)
Candida Infections
The vagina creates its own environment and maintains a balance among the normal
bacteria found there and the hormonal changes in a woman’s body. Infections can occur
when the vaginal ecosystem has been changed by certain medications such as
antibiotics, hormones, oral contraceptives, spermicides, douches, vaginal medication and
also by sexual intercourse, sexually transmitted diseases, stress and change in sexual
partners.
A study showed that the normal gut flora have a natural resistance to
Candida albicans but this may be reduced when antibiotics are taken.(1)
Many women suffer from recurrent yeast infections indicating that there must be a
reservoir of Candida albicans. A trial concluded that the endometrium is not a common
reservoir for Candida albicans.(3) However, there is a significant association shown
between the presence of yeasts in the rectum and in the vagina.(5) A study discovered a
correlation between the occurrence of Candida albicans in the gut and in the vagina, by
swabbing both the rectum, and vaginas of healthy women. The rectum is therefore
Protexin Health Care – Technical Notes
Probiotics and Candida Infections
June 2005 - This document supersedes all previous document
Probiotics International Ltd., Matts Lane, Stoke sub Hamdon, Somerset, TA14 6QE
www.protexin.com
1
thought to be the reservoir for Candida infections and the cause of re-infection of the
vagina.(8) Further work showed that the presence of yeast is higher in the lower bowel
of women during a Candida infection than in those who do not have any symptoms.(4)
Treatment of Candidiasis
The most common treatment for vaginal yeast infections is an antifungal cream or
pessary, which is applied directly to the area of infection. However although this may
be effective in relieving symptoms and reducing the local infection, it will not affect the
rate of relapse of Candida infections.(6) Results of a trial suggested that there is value in
eliminating any intestinal reservoir of Candida when treating patients with vaginal
Candidiasis.(7) A review of the literature concluded that due to the recurrent nature of
Candida vaginitis a complete treatment would not be possible without removing Candida
albicans from the gut.(9)
Prevention by Probiotics
Probiotic microbes not only suppress the growth of Candida in the alimentary tract and
vagina, but they also inhibit the adherence of Candida to epithelial surfaces. The ability
of probiotic bacteria to stimulate innate and acquired immune systems in the host and
activate phagocytic cells is also thought to play a role in the inhibition of Candida. A
study found that high doses of bifidobacterium have a value in increasing the patient
resistance to infection by Candida albicans. (2)
The inhibition of Candida by probiotic bacteria, in the alimentary and vaginal tracts,
represents a key, first-line defense against mucosal and systemic candidiasis.
Lactobacillus acidophilus is known to decrease both Candidal colonisation and infection,
threefold in patients consuming this species.(11) In another study a probiotic containing
Lactobacillus rhamnosus was found to be safe for daily use in healthy women, reducing
colonisation of the vagina by potential pathogenic bacteria and yeast. (12)
It is thought that although probiotics may not be able to cure yeast vaginitis, they are
useful in addition to anti-fungal drugs and to reduce the risk of recurrence. The use of
probiotics can help fortify natural resistance of the gut microflora to Candida albicans,
particularly if antibiotics are used.(1)
Protexin Health Care – Technical Notes
Probiotics and Candida Infections
June 2005 - This document supersedes all previous document
Probiotics International Ltd., Matts Lane, Stoke sub Hamdon, Somerset, TA14 6QE
www.protexin.com
2
Conclusion
In a normal healthy individual, overgrowth of Candida albicans is prevented by the
commensal bacteria, found in the usual microflora. However, antibiotics have the ability
to disrupt the bacterial populations within the gut. This can then lead to the overgrowth
of undesirable microorganisms like Candida albicans. If probiotics are used in this
situation then, although Candida albicans will not be completely eliminated, yeast counts
will be reduced.
Probiotics help to prevent and reduce candida infections of the vagina by:
 Increasing the number of probiotic and indigenous lactobacilli moving from the
rectal skin to the vagina.
 Reducing the number of pathogens moving from the rectal skin to the vagina.
 Enhancing the intestinal mucosal immunity which, in turn affects vaginal
immunity making the environment less receptive to pathogenic organisms.
 Reducing the pH of the vaginal tract, making it an unfavourable environment for
yeast growth.
 Decreasing the number of yeast organisms within the gut, this acts as a reservoir
for re-infection.
It is thought that although probiotics may not be able to cure yeast vaginitis, they are
useful in addition to anti-fungal drugs for the treatment of Candida infections. As a
preventive they are safe for daily use and effective at decreasing yeast levels within the
gut, reducing the risk of recurrence. Probiotics can therefore, help to maintain vaginal
health, prevent candida infections and also reduce the risk bacterial vaginosis.
Protexin Health Care – Technical Notes
Probiotics and Candida Infections
June 2005 - This document supersedes all previous document
Probiotics International Ltd., Matts Lane, Stoke sub Hamdon, Somerset, TA14 6QE
www.protexin.com
3
References
1. Payne S, Gibson G, Wynne A, Hudspith B, Brostoff J, Tuohy K (2003). In vitro studies on
colonization resistance of the human gut microbiota to Candida albicans and the effects of
tetracycline and Lactobacillus plantarum LPK. Curr Issues Intest Microbiol. 4(1):1-8.
2. Lykova EA, Vorob'ev AA, Bokovoi AG, Pobedinskaia IN, Gevondian VS, Gevondian NM,
Mitrokhin SD, Minaev VI, Dzis NB, Makkaveeva LF, Kovalev IV, Murashova AO, Bondarenko
VM (2000). [Disruption of microbiocenosis of the large intestine and the immune and
interferon status in children with bacterial complications of acute viral infections of the
respiratory tract and their correction by high doses of bifidumbacterin forte] Antibiot
Khimioter. 45(10):22-7.
3. Tasdemir M, Tasdemir I, Tasdemir S, Tavukcuoglu S (1997). Endometrium is not a reservoir
for recurrent vaginal candidiasis. Clin Exp Obstet Gynecol. 24(2):112-3.
4. Fong IW. The rectal carriage of yeast in patients with vaginal candidiasis (1994). Clin Invest
Med. 17(5):426-31.
5. Peer AK, Hoosen AA, Seedat MA, van den Ende J, Omar MA (1993). Vaginal yeast infections
in diabetic women. S Afr Med J. 83(10):727-9.
6. Spinillo A, Carratta L, Pizzoli G, Lombardi G, Cavanna C, Michelone G, Guaschino S (1992).
Recurrent vaginal candidiasis. Results of a cohort study of sexual transmission and intestinal
reservoir. J Reprod Med. 37(4):343-7.
7. Nystatin Multicenter Study Group (1986). Therapy of candidal vaginitis: the effect of
eliminating intestinal Candida. Am J Obstet Gynecol. 155(3):651-5.
8. Leegaard M (1984). The incidence of Candida albicans in the vagina of "healthy young
women". How often do they have symptoms? Possible etiological factors. Acta Obstet
Gynecol Scand. 63(1):85-9.
9. Miles MR, Olsen L, Rogers A (1977). Recurrent vaginal candidiasis. Importance of an
intestinal reservoir. JAMA. 238(17):1836-7.
10. Reid G, Bruce AW, Fraser N, Heinemann C, Owen J, Henning B (2001). Oral probiotics can
resolve urogenital infections. FEMS Immunol Med Microbiol. 30(1):49-52.
11. Hilton E, Isenberg HD, Alperstein P, France K, Borenstein MT (1992). Ingestion of yogurt
containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med.
116(5):353-7.
12. Reid G, Charbonneau D, Erb J, Kochanowski B, Beuerman D, Poehner R, Bruce AW (2003).
Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal
flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med
Microbiol. 35(2):131-4.
13. Alderberth I (1999). Establishment of a normal intestinal microflora in the newborn infant.
In: Hanson LA, ed.
Probiotics, Other Nutritional Factors, and Intestinal Microflora .
Philadelphia, PA: Lippincott-Raven; 63-78
Protexin Health Care – Technical Notes
Probiotics and Candida Infections
June 2005 - This document supersedes all previous document
Probiotics International Ltd., Matts Lane, Stoke sub Hamdon, Somerset, TA14 6QE
www.protexin.com
4