This article was written by one of The Food Medic team; registered dietitian – Maeve Hanan.
You may have heard of the candida diet as a treatment for candida overgrowth or a yeast infection. But what is this diet and does it actually work? Read on to find out!
What is candida?
Candida is a type of yeast that is found all over the body, including the mouth, skin, intestines, and vagina.
This doesn’t usually cause any problems, unless an overgrowth of candida occurs. Out of the 150 known species of Candida, only 15 are linked with a candida infection (A.K.A. candida overgrowth, candidiasis, a yeast infection or thrush) (1).
The risk of a candida infection is higher for (2, 3, 4):
- Those with a weakened immune system
- People in critical care or receiving parenteral nutrition (nutrition through a vein)
- Those who have had multiple abdominal surgeries
- People who have recently been on high doses or prolonged antibiotics
- Those who have kidney failure or diabetes
- Preterm babies
- Those with gut conditions including coeliac disease, IBS and stomach ulcers
- People who inject drugs
- Those with high stress levels
Although candida overgrowth is common this varies in severity, with sepsis being a worst case scenario (5, 6).
More common symptoms include:
- Genital itching, burning, discomfort and thick white discharge
- Redness and white patches on the tongue, gums, cheeks and throat
- Pain in the mouth
- Cracks in the corners of the mouth
- Taste changes
Watch out for claims that candida overgrowth can lead to vague symptoms like
fatigue, brain fog, low mood (etc.) as this isn’t evidence-based.
Candida overgrowth is often treated with antifungal medication or creams (6).
What is the candida diet?
Some people claim that the candida diet is anti-inflammatory, promotes gut health and can help in the treatment of candida overgrowth. The validity of these claims is discussed below.
This diet involves (7):
- A low intake of sugar
- Avoiding gluten
- Avoiding alcohol
- Limiting dairy – probiotic yogurt and butter tend to be allowed in moderation
- Minimising caffeine
- Avoid refined oils
- Avoiding certain additives and processed foods
- Consuming fermented foods and probiotics
Foods encouraged on the diet include (7):
- Non-starchy vegetables
- Lower-sugar fruit
- Lean proteins e.g. chicken and fish
- Naturally gluten-free grains e.g. quinoa
- Fats like olive oil, avocado and coconut oil
- Certain ‘low mold’ nuts and seeds
- Herbs and spices
- Sweeteners like stevia, xylitol and erythritol
- Fermented foods like e.g. probiotic yogurt and sauerkraut
What does the evidence-base say?
Sugar & Carbohydrates
Although sugar (including lactose found in dairy) can promote candida growth in a petri dish and on the surface of dentures, this doesn’t apply directly to the human body (8, 9, 10, 11).
Higher blood glucose levels have been linked with a higher risk of candida infections in those with diabetes (12). There is less research related to people who don’t have diabetes, but one study of 62 healthy women found blood glucose levels were higher in those with recurrent vaginal candidiasis cases than the control group both on average and after consuming oral glucose (13).
However, a study of 28 healthy volunteers found no link between usual intake of refined carbohydrate intake (like sugar and white bread) and candida levels and candida levels didn’t increase in response to a high-sugar diet overall (14).
Gluten & Grains
In terms of gluten, higher candida levels have been seen in those with coeliac disease and some researchers question whether candida infections might even be a risk factor in those susceptible to coeliac disease due to interactions in the immune system (15, 16). But claiming that gluten increases the risk of candida overgrowth across the board is not backed by good evidence.
Another small study from 2019 found that refined wheat flour intake was linked to the presence of an infectious type of candida strain in the gut, whereas wheat substitutes were not (17). This study also found that a higher intake of cheese and quark was associated with lower candida levels, this is interesting as cheese is discouraged in the candida diet.
Probiotics
A recent literature review highlighted that evidence is increasing for the role of certain probiotics, such as Lactobacillus, Bifidobacterium, and Saccharomyces in the management of oral and vulvovaginal candidiasis (18). But for other types of candida infection, like skin candidiasis, evidence is lacking, so ongoing research is needed in this area.
Other Foods
As inflammation may increase the risk of candida overgrowth, in theory foods that have an anti-inflammatory effect may be beneficial (19). We don’t have good evidence related to anti-inflammatory foods and candidiasis to back this up, but diet patterns linked with lower inflammation levels, like the Mediterranean diet, are beneficial for overall health (20).
A pilot study from 2018 found that after 3 months significantly higher percent of participants were cured of candida overgrowth when they followed a candida diet as well as using anti-fungal treatment, as compared with using the antifungal treatment alone (21). This diet also included the following supplements: omega-3, linseed oil, evening primrose oil, a multivitamin and a probiotic.
A handful of animal and petri-dish studies have found that other foods may have an antifungal effect against candida, such as the sweetener xylitol and coconut oil (22, 23).
Nutritional Considerations
Some of the foods recommended in the candida diet are nutritious and can be health-promoting, such as fruit, vegetables, grains, chicken, fish, olive oil, avocado, nuts, seeds, herbs, spices, fermented foods and probiotics.
But this diet also places a lot of unnecessary restrictions, including only allowing certain types of fruit and vegetables, grains, nuts, seeds and dairy products. As the overall evidence to support this diet is low, the cons of these restrictions are likely to out-weigh any possible pros for many people.
For example, unnecessarily limiting the diet can do more harm than good to our gut health, immune system, relationship with food (etc.) if this becomes restrictive. Whereas, a varied and satisfying diet is good for both our physical and mental health.
Following a restrictive diet can also be difficult and stressful, and stress has been linked with higher (3).
Importantly, we can get the benefits of the candida diet without the risks of the restrictive elements by following a balanced and varied Mediterranean-style diet. Beyond this, any dietary experiments related to candida overgrowth should ideally only be trialled one at a time with the support of a dietitian.
Checkout this article for tips for eating well.
Summary
Although there is some more evidence emerging related to aspects of the candida diet, like probiotic use, unfortunately many of the claims about the candida diet are blown out of proportion. So there isn’t enough evidence to advise the candida diet for the management of this condition.
A balanced and varied diet benefits our overall health, so this could theoretically include candida overgrowth management.
But the strongest evidence for treating a candida infection like thrush is for established anti-fungal treatments.
See here for information from the NHS related to Thrush in men and women.
References:
- Yapar, N. (2014). Epidemiology and risk factors for invasive candidiasis. Therapeutics and clinical risk management, 10, 95. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/24611015]
- CDC Website (2020) “Invasive Candidiasis Risk & Prevention” [accessed February 2021 via: https://www.cdc.gov/fungal/diseases/candidiasis/invasive/risk-prevention.html]
- Meyer, H., Goettlicher, S., & Mendling, W. (2006). Stress as a cause of chronic recurrent vulvovaginal candidosis and the effectiveness of the conventional antimycotic therapy. Mycoses, 49(3), 202-209. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/16681811/]
- Kumamoto, C. A. (2011). Inflammation and gastrointestinal Candida colonization. Current opinion in microbiology, 14(4), 386-391. [accessed February 2021 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163673/]
- Bongomin, F., Gago, S., Oladele, R. O., & Denning, D. W. (2017). Global and multi-national prevalence of fungal diseases—estimate precision. Journal of fungi, 3(4), 57. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/29371573/]
- Rafiq, N. B. (2021). Candidiasis. StatPearls. [accessed February 2021 via: https://www.ncbi.nlm.nih.gov/books/NBK560624/#article-18814.s9]
- The Candida Diet Website “What Is The Candida Diet?” [accessed February 2021 via: https://www.thecandidadiet.com/]
- Listiana-Kriswandini, I., Budi-Rahardjo, M., Soesilawati, P., & Prisca-Suciadi, A. (2019). Detection of Candida albicans biofilm proteins induced by glucose, lactose, soy protein, and iron. Journal of Clinical and Experimental Dentistry, 11(6), e542. [accessed February 2021 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645256/]
- Pizzo, G., Giuliana, G., Milici, M. E., & Giangreco, R. (2000). Effect of dietary carbohydrates on the in vitro epithelial adhesion of Candida albicans, Candida tropicalis, and Candida krusei. The new microbiologica, 23(1), 63-71. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/10946407/]
- Man, A., Ciurea, C. N., Pasaroiu, D., Savin, A. I., Toma, F., Sular, F., … & Mare, A. (2017). New perspectives on the nutritional factors influencing growth rate of Candida albicans in diabetics. An in vitro study. Memórias do Instituto Oswaldo Cruz, 112, 587-592. [accessed February 2021 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572443/]
- Santana, I. L., Gonçalves, L. M., Vasconcellos, A. A. D., da Silva, W. J., Cury, J. A., & Cury, A. A. D. B. (2013). Dietary carbohydrates modulate Candida albicans biofilm development on the denture surface. PloS one, 8(5), e64645. [accessed February 2021 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667795/]
- Rodrigues, C. F., Rodrigues, M. E., & Henriques, M. (2019). Candida sp. infections in patients with diabetes mellitus. Journal of clinical medicine, 8(1), 76. [accessed February 2021 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352194/]
- Donders, G. G., Prenen, H., Verbeke, G., & Reybrouck, R. (2002). Impaired tolerance for glucose in women with recurrent vaginal candidiasis. American journal of obstetrics and gynecology, 187(4), 989-993. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/12388993/]
- Weig, M., Werner, E., Frosch, M., & Kasper, H. (1999). Limited effect of refined carbohydrate dietary supplementation on colonization of the gastrointestinal tract of healthy subjects by Candida albicans. The American journal of clinical nutrition, 69(6), 1170-1173. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/10357735/]
- Harnett, J., Myers, S. P., & Rolfe, M. (2017). Significantly higher faecal counts of the yeasts candida and saccharomyces identified in people with coeliac disease. Gut Pathogens, 9(1), 1-8. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/28484520/]
- Aaron, L., & Torsten, M. (2020). Candida albicans in celiac disease: a wolf in sheep’s clothing. Autoimmunity Reviews, 19(9), 102621. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/32693029/]
- Jeziorek, M., Frej-Madrzak, M., & Choroszy-Król, I. (2019). The influence of diet on gastrointestinal Candida spp. colonization and the susceptibility of Candida spp. to antifungal drugs. Roczniki Państwowego Zakładu Higieny, 70(2). [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/31215785/]
- Andrade, J. C., Kumar, S., Kumar, A., Černáková, L., & Rodrigues, C. F. (2021). Application of probiotics in candidiasis management. Critical reviews in food science and nutrition, 1-16. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/34024191/]
- Kumamoto, C. A. (2011). Inflammation and gastrointestinal Candida colonization. Current opinion in microbiology, 14(4), 386-391. [accessed February 2021 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163673/]
- Tsigalou, C., Konstantinidis, T., Paraschaki, A., Stavropoulou, E., Voidarou, C., & Bezirtzoglou, E. (2020). Mediterranean diet as a tool to combat inflammation and chronic diseases. An overview. Biomedicines, 8(7), 201. [accessed February 2021 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400632/]
- Otašević, S., Momčilović, S., Petrović, M., Radulović, O., Stojanović, N. M., & Arsić-Arsenijević, V. (2018). The dietary modification and treatment of intestinal Candida overgrowth–a pilot study. Journal de Mycologie Médicale, 28(4), 623-627. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/30166063/]
- Gunsalus, K. T., Tornberg-Belanger, S. N., Matthan, N. R., Lichtenstein, A. H., & Kumamoto, C. A. (2016). Manipulation of host diet to reduce gastrointestinal colonization by the opportunistic pathogen Candida albicans. MSphere, 1(1), e00020-15. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/29422459/]
- Talattof, Z., Azad, A., Zahed, M., & Shahradnia, N. (2018). Antifungal Activity of Xylitol against Candida albicans: An in vitro Study. The Journal of Contemporary Dental Practice, 19(2), 125-129. [accessed February 2021 via: https://pubmed.ncbi.nlm.nih.gov/29422459]
