The Yeast Within This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
From The June 1999 Issue of Nutrition Science News
By Patricia DeProspero Rogers, N.P.C., and Beverly Whipple, Ph.D., R.N.How many women seek a remedy to ease the intense vaginal itching and burning symptoms of a yeast infection? As many as three of every four women in the United States--a substantial 75 percent--experience a vaginal yeast infection at least once in their lifetime.
Many women suffer from chronic or repeated bouts of vaginitis, an inflammation of the vagina brought on by a yeast infection. [1] Although some women treat their infection with over-the-counter (OTC) medications, alternative therapies exist for treating and preventing this often-recurring disorder without having to rely on the chronic use of drugs.
Vaginal yeast infections result from an overgrowth of Candida albicans, a single-cell fungus present in healthy genital and intestinal tracts. Many factors can contribute to candida overgrowth. Cross contamination can occur through oral contact and from other potential reservoirs of yeast such as the nearby anus or urethra, or the vagina's pH can be upset by douching or natural hormonal shifts. The vaginal ecosystem is a delicate balance of organisms and can be extremely sensitive to both internal and external changes, anything from diet to the type of undergarments worn. The predominant organisms normally found in the vagina are Lactobacillus acidophilus and Corynebacterium vaginale. [2] These organisms maintain an acidic vaginal environment with a pH of 4 to 4.5. [3] Since lactobacillus and corynebacterium are responsible for metabolizing the sugars glycogen and glucose, which are favorite foods for candida and other yeasts, a healthy amount of these organisms can stave off candida overgrowth. [4 ]
Premenstrually, the vagina often becomes more acidic--ironically, possibly from the result of a temporary overgrowth of lactobacillus [4]--and as a result a few women suffer from a cyclic vaginal irritation known as cytolytic vaginosis, which is often confused with a yeast infection. [5 ]
Candidiasis primarily affects women of child-bearing age, so hormones are thought to be a causative factor. [4] Incidence increases during pregnancy and with oral contraceptive use, probably because of elevated serum hormones and increased amounts of vaginal glycogen. [4] Some evidence suggests C. albicans has estrogen receptors, and the increased estrogen associated with pregnancy and oral contraception may increase the risk of candida overgrowth. [6] The use of antibiotics that can eradicate helpful bacteria such as lactobacillus is a fairly common culprit in yeast overgrowth. [1] An underlying immune system failure, as in human immunodeficiency virus infection (HIV), can also be a problem. In fact, a recurring vaginal infection may be the first sign of HIV in women and should not be overlooked. [7] Any customers with compromised immune systems, as in those with HIV, diabetes or stress, or those who are corticosteroid users, have a reduced ability to fight infection, as demonstrated by a decrease in the number of T lymphocytes and increased T-cell suppressors. [4]
Allergic release of histamine can also paralyze cell-mediated immune response and promote proliferation of candida. [8] This theory recently underwent some interesting inquiry. A 28-month study of 195 women indicated recurrent vaginal candidiasis is statistically associated with allergic rhinitis, or hay fever. A total of 71 percent of women with vaginal yeast infections also had perennial allergic rhinitis, compared to only 42 percent in the control group. [9]
Diagnosis and Treatment
Diagnosing a vaginal yeast infection can be tricky, although some women who have had one in the past will know immediately when they have another. Hallmark symptoms are intense vaginal itching and burning, which may be accompanied by a thick, white, cottage-cheeselike vaginal discharge and genital redness or swelling. Women should see a health care provider if this is the first occurrence or if symptoms recur. Other more unusual problems, including sexually transmitted diseases, may be present, and cultures should be done to rule out other possibilities.
For more severe yeast infections, customers can combine 1/2 tablespoon goldenseal and 1/2 tablespoon myrrh to 3 cups water, boiled to make a tea, cooled and strained, then used in a douche periodically as needed. In addition, self-diagnosis is not always accurate. One study found that only 34 percent of 552 nonmedically trained patients could identify the signs and symptoms of vaginal yeast infections in case studies--and 66 percent of the women had been previously diagnosed with one. [2] Women should never treat the problem without a health care practitioner unless they are absolutely sure of the diagnosis.
Since yeast overgrowth can be caused by a multitude of problems, as mentioned earlier, yeast infection treatment should be multifaceted. Following are some that are particularly useful.Diet and stress reduction: Those with candidiasis should get adequate sleep and decrease emotional, spiritual and psychological stresses, particularly before the onset of menses. [10] Maintaining cell-mediated immunity is believed to be important in candidiasis prevention. [4] Diet recommendations are varied and should be individualized based on subjective reactions.
The following treatments are commonly used, and although many women report that the treatments help tremendously, there is little substantiation for them through medical research. [4] In general, refined sugar and simple carbohydrates should be eliminated from the diet because yeast growth is facilitated by the presence of sugar. Dairy products may also increase yeast growth because of the high lactose content--an exception being unsweetened, unflavored, nonprocessed yogurt. Eating eight ounces of this type of yogurt daily has been found to reduce the risk of candida infection by one-third, primarily because it helps the body maintain a normal population of lactobacillus. [8 ]
Additionally, nutritional supplements such as acidophilus have been recommended by many health care providers within the allopathic community, with good results. The recommended oral dosage is 40 million to 1 billion units/day (generally 4 to 6 capsules/day). [10] A good multivitamin with at least 50 mg of each of the B vitamins should be taken daily to boost the immune system, along with 400 to 800 IU vitamin E daily. Vitamin C at 1,000 mg per day is recommended to boost immunity and to theoretically increase the acidity of vaginal secretion. [1, 10 ]
Vaginal inserts: For recurrent bouts of candida, 600 mg boric acid in a gelatin capsule inserted vaginally at bedtime for 14 days has been prescribed by allopathic doctors for quite some time, with no immediate side effects. [11, 13 ]Caution should be used with this method for pregnant women because some studies indicate that it is potentially toxic to fetuses. [12 ]
Other home remedies used before the advent of current antifungals include gentian violet (C25H30CIN3) and yogurt. Gentian violet, a traditional antifungal, is usually found in a 1 or 2 percent solution in water. It is swabbed on the entire vulvar area and into the vagina once or twice daily for several days, or once a week for four weeks for recurrent episodes. [4] Gentian violet permanently stains clothing, so thick menstrual pads are a must. Also, some women are sensitive to this agent and should test a less sensitive area of the skin before genital application.
Plain, unflavored yogurt may also be used intravaginally. Customers can fill plastic tampon applicators with one or two tablespoons of unsweetened, unflavored, nonprocessed yogurt and apply as they would a vaginal cream. The acidophilus found in yogurt may counter yeast overgrowth. [4]
Potassium sorbate, an effective fungicide used in beer brewing to stop the growth of yeast, is available at homebrew supply stores and some natural products stores. The treatment is aimed at decreasing yeast growth. Direct customers to make a 3 percent solution by adding 8 g (about one tablespoon) of potassium sorbate to a cup of water. A cotton tampon saturated with the solution should be inserted at bedtime for several days until symptoms are gone. [4]
Vaginal douches: Douching disrupts the normal vaginal flora and is therefore not recommended for healthy women, but it can be helpful in treating specific infections. Acidic douches can help restore the vagina's natural pH. A douche made with two tablespoons of vinegar, the juice of half a lemon or one teaspoon of vitamin C per quart of water may clear up a mild infection. This remedy is commonly recommended by health care practitioners, though again, little research has been conducted on its efficacy. [4] For more severe infections, customers can combine 1/2 tablespoon goldenseal (Hydrastis canadensis) and 1/2 tablespoon myrrh (Commiphora molmol) to 3 cups water, boiled to make a tea, cooled and strained, then used in a douche periodically as needed. [4 ]
Antifungal medications: The commonly used OTC medications Miconazole, Clotrimazole, Terconazole and Nystatin all belong to the azole class of drugs and are potent antifungals. [8] While most adverse reactions to these medications are minor (vaginal burning, headache or abdominal cramps), caution should be taken that the problem may, in fact, not be yeast at all. A health care provider should perform microscopic tests to determine the nature of the problem. [2] Additionally, the now-popular oral antifungal, Fluconazole, interacts badly with a variety of other medications, including warfarin, oral hypoglycemics and phenytoin, and is not recommended during pregnancy. [4]
An Ounce of Prevention
Prevention is truly the best way to avoid the discomfort of vaginal yeast infections. Share the following tips with your customers who wish to prevent recurrent yeast infections:
Wear loose, all-cotton underwear (cotton crotch panels often have an outer layer of nylon). Avoid pantyhose and tight pants and sterilize or replace underwear that may have been worn during a yeast infection. Normal washing does not remove yeast; it can be killed only by using chemicals or high heat. Some ways to do this are by soaking the underwear in a bleach solution, boiling it or microwaving damp underwear on high for five minutes. [4 ]
Avoid chemicals such as perfumed bubble bath, deodorant tampons and scented toilet paper. An allergic reaction can leave the vagina susceptible to secondary infection. [10]
Avoid antibiotics, steroids and oral contraceptives unless absolutely necessary.
Keep the immune system strong with good diet, exercise, vitamins as mentioned and no smoking. If a woman has recurrent infections, she should be evaluated for HIV or other diseases that compromise the immune system. [7]
Wipe with toilet paper from front to back after elimination, and thoroughly dry the vaginal area after bathing or swimming, possibly with a blow dryer on a very low setting.
Avoid sexual intercourse while symptoms persist, and have sexual partners evaluated for yeast infection as well. There is some evidence that treating a partner may be helpful in halting the cycle of recurrence, particularly in terms of oral-genital contact. This condition is not considered a sexually transmitted disease, since it is found in celibate women and because C. albicans is part of normal vaginal flora, but it is associated with sexual activity. There is an increased incidence of candidiasis at the time most women become sexually active. [8]
Although many women will experience a yeast infection at least once in their lifetime, this is not a normal condition. It is important to remind your customers that if their symptoms should recur, worsen or fail to subside, a health care provider should be consulted. Also, while vaginal candidiasis is often considered a mild problem that can be self-treated, yeast overgrowth in the mouth, known as thrush, in an otherwise healthy adult can be a sign of AIDS and should not be overlooked.
References:1. Reynolds T, editor. Alternative therapies and women's health. National Women's Health Report 1995;17(3):4.
2. Ferris DG. Self-treatment of vulvovaginal candidiasis. Emergency Medicine 1997 Feb;56-7.
3. Sobel JD. Vaginitis: current concepts. New Engl J Med 1997;337(26):1896-1902.
4. Carcio HA, Secor MC. Vulvovaginal candidiasis: a current update. Nurse Practitioner Forum 1992;3(3):135-44.
5. Secor RM. Cytolytic vaginosis: a common cause of cyclic vulvovaginitis. Nurse Practitioner Forum1992;3(3):145-8.
6. Horowitz BJ, et al. Evolving pathogens in vulvovaginal candidiasis: implications of patient care. J Clin Pharmacol 1990;32:248-55.
7. Smeltzer SC, Whipple B. Women and HIV infection. IMAGE: J Nursing Scholarship 1991;23(4):249-56.
8. Folk remedy seems to help fight vaginal yeast infection. New York Times 1992 Mar 10.
9. Moraes PS. Recurrent vaginal candidiasis and allergic rhinitis: a common association. Ann Allergy Asthma Immunol 1998;81(2):165-9.
10. Northrup C. Women's bodies, women's wisdom: creating physical and emotional health and healing. (NY): Bantam Books. p 303-5.
11. Horowitz BJ. Mycotic vulvovaginitis: a broad overview. Am J Obstet Gynecol 1991;165:1188-91.
12. Sobel JD. Treating resistant vaginal infections. Physician Assistant 1996 Apr:116-120.
13. Williams DG. Self-test for vaginal infections. Alternatives for the Health Conscious Individual 1997;7(3):20-1.
14. Culver BD. Vaginitis comment: letter to the editor. New Engl J Med 1997;338(21):1548-9.
Patricia DeProspero Rogers, M.S., N.P.C., R.N.C., is a nurse practitioner at the Cherry Hill Women's Center, Cherry Hill, N.J. Beverly Whipple, Ph.D., R.N., F.A.A.N., is a professor in the College of Nursing at Rutgers University, New Brunswick, N.J. She is president of the American Association of Sex Educators, Counselors and Therapists.
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