Quick viewing(Text Mode)

Candida Auris (C

Candida Auris (C

Gastrointestinal Health from a Functional Medicine Perspective Part 7A: Dybiosis part 11

IFMNT Certificate of Training 18-19

Presented By Susan Allen-Evenson RDN, CCN, FMNS

©2020 COPYRIGHT. ALL RIGHTS RESERVED Dysbiosis Antibiotic Use Prevalence - CDC

“In 2015 alone, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States, enough for five out of every six people to receive one antibiotic prescription each year. At least 30 percent of these antibiotic prescriptions were unnecessary.”

Antibiotic Use in Outpatient Settings, 2017. Centers for Disease Control and Prevention. https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html. Published August 8, 2019. Accessed May 13, 2020.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Antibiotic Resistance

• A 2019 study found that the overuse of antimicrobial drugs is poised to cause “a global crisis” that could have a severe and lasting impact on society. • According to this report, the overuse of antibiotics is creating drug-resistant “superbugs” that could kill 10 million people a year by as soon as 2050.

Bollinger T, rON, Ron. Antibiotic Overuse Could Kill 10 Million Each Year. The Truth About Cancer. https://thetruthaboutcancer.com/antibiotic-overuse/?utm_campaign=ttad. Published June 13, 2019. Accessed May 13, 2020.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Antimicrobial vs Antibiotic Resistance For clarification, the name, “antimicrobial resistance,” covers all types of germs, more scientifically called microbes, including bacteria, fungi, and viruses, that can cause infections. “Antibiotic resistance” specifically refers to bacteria and does not include other types of germs. Bacteria cause most resistant infections, so the term, “antibiotic resistance” tends to be more common.

How to Explain Antimicrobial Resistance to Your Friends and Family (With Infographics) July 12, 2018 bioMérieux Connection (website) https://www.biomerieuxconnection.com/2018/07/12/explain-antimicrobial-resistance-friends-family-infographics/ (Accessed May 16, 2020) ©2020 COPYRIGHT. ALL RIGHTS RESERVED Antibiotic Resistance, CDC stats

• According to the report, more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. • CDC’s Antibiotic Resistance Threats in the United States, 2019 (2019 AR Threats Report) includes the latest national death and infection estimates that underscore the continued threat of antibiotic resistance in the U.S. – Includes a list of urgent, serious, and concerning threats and a watch list…

Biggest Threats and Data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugresistance/biggest-threats.html. Published March 13, 2020. Accessed May 13, 2020.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Antibiotic Resistance- Urgent Threats

• Carbapenem-resistant Acinetobacter • Drug-resistant auris (C. auris) • Clostridioides difficile (C. difficile) • Carbapenem-resistant Enterobacteriaceae (CRE) • Drug-resistant Neisseria gonorrhoeae (N. gonorrhoeae)

Biggest Threats and Data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugresistance/biggest-threats.html. Published March 13, 2020. Accessed May 13, 2020.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Antibiotic Resistance- Serious Threats • Drug-resistant Campylobacter • Drug-resistant Candida • ESBL-producing Enterobacteriaceae • Vancomycin-resistant Enterococcus (VRE) • Multidrug-resistant Pseudomonas aeruginosa (P. aeruginosa) • Drug-resistant nontyphoidal Salmonella • Drug-resistant Salmonella serotype Typhi • Drug-resistant Shigella • Methicillin-resistant Staphylococcus aureus (S. aureus) (MRSA) • Drug-resistant Streptococcus pneumoniae (S. pneumoniae) • Drug-resistant Tuberculosis

Biggest Threats and Data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugresistance/biggest-threats.html. Published March 13, 2020. Accessed May 13, 2020.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Antibiotic Resistance- Concerning Threats

• Erythromycin-resistant Group A Streptococcus • Clindamycin-resistant Group B Streptococcus

Biggest Threats and Data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugresistance/biggest-threats.html. Published March 13, 2020. Accessed May 13, 2020.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Antibiotic Resistance- Watch List

• Azole-resistant fumigatus • Drug-resistant Mycoplasma genitalium (M. genitalium) • Drug-resistant Bordetella pertussis (B. pertussis)

Biggest Threats and Data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugresistance/biggest-threats.html. Published March 13, 2020. Accessed May 13, 2020.

©2020 COPYRIGHT. ALL RIGHTS RESERVED How to Explain Antimicrobial Resistance to Your Friends and Family (With Infographics) July 12, 2018 bioMérieux Connection (website) https://www.biomerieuxconnection.com/2018/07/12/explain-antimicrobial-resistance-friends-family-infographics/ (Accessed May 16, 2020) ©2020 COPYRIGHT. ALL RIGHTS RESERVED How to Explain Antimicrobial Resistance to Your Friends and Family (With Infographics) July 12, 2018 bioMérieux Connection (website) https://www.biomerieuxconnection.com/2018/07/12/explain-antimicrobial-resistance-friends-family-infographics/ (Accessed May 16, 2020) ©2020 COPYRIGHT. ALL RIGHTS RESERVED Contribution: Farming Practices

• Common food germs like E.Coli and Salmonella become resistant when farms use antimicrobials inappropriately, usually as an attempt to promote animal growth rather than to treat infections. • Those resistant infections can spread to humans when we consume contaminated food. To combat the issue, farms should only use antibiotics with veterinary oversight to manage and treat infections, not to promote growth.

How to Explain Antimicrobial Resistance to Your Friends and Family (With Infographics) July 12, 2018 bioMérieux Connection (website) https://www.biomerieuxconnection.com/2018/07/12/explain-antimicrobial-resistance-friends-family-infographics/ (Accessed May 16, 2020) ©2020 COPYRIGHT. ALL RIGHTS RESERVED What must be done to help?

• Use proper hygiene practices, such as washing hands regularly. • Clean surfaces like tables, counters, and doorknobs in homes and especially in public places like schools and restaurants. • Healthcare facilities must, and typically do, pay special attention to employee hygiene and thorough environmental sanitation. • Healthcare facilities and the food industry must work to reduce improper and sub-optimal antimicrobial use. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Types of Flora Disruptions in General • Parasites – Hookworm, tapeworm, pinworm, amoeba • / – Candida, Rhodotorula, Geotrichum, , and • Bacterial infections – H. Pylori, Clostridium Difficile, Campylobacter, Entero- Hemorrhagic Escherichia Coli (EHEC)

1. Travers M-A, Florent I, Kohl L, Grellier P. for the control of parasites: an overview. Journal of parasitology research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182331/. Published 2011. Accessed May 13, 2020. 2. Hallen-Adams HE, Suhr MJ. Fungi in the healthy human . Virulence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411236/. Published April 3, 2017. Accessed May 13, 2020. 3. Britton RA, Versalovic J. Probiotics and gastrointestinal infections. Interdisciplinary perspectives on infectious diseases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2648624/. Published 2008. Accessed May 13, 2020. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Parasites Common Parasites

A parasite is an organism that lives on or in a host and gets its food from or at the expense of its host. • Trichomoniasis • Giardiasis • cryptosporidiosis • Toxoplasmosis Parasitic infections can be caused by three types of organisms: • Protozoa - single-celled organisms such as Giardia • Helminths - commonly known as worms – flatworms, tapeworms, thorny-headed worms, and roundworms. • Ectoparasites - multicelled organisms that live on or feed off your skin. They include some insects and arachnids, such as mosquitos, fleas, ticks, and mites.

Kinman T. Parasitci Infection. Healthline (webite) Sept 20, 2016. https://www.healthline.com/health/parasitic-infections#risk-factors. https://www.healthline.com/health/parasitic-infections Accessed May15, 2020

©2020 COPYRIGHT. ALL RIGHTS RESERVED Ann Louis Gittleman PhD, CNS - excerpt from For Parasites

“Parasites are the most immunosuppressive agents in the human body. As my colleague Dr. Leo Galland so eloquently wrote, “I strongly believe that every patient with disorders of immune function, including multiple allergies (especially food allergy), and patients with unexplained fatigue or with chronic bowel symptoms should be evaluated for the presence of intestinal parasites.”

[PDF] for Parasites - Ann Louise Gittleman - Free Download PDF. [PDF] for Parasites - Ann Louise Gittleman - Free Download PDF. https://ziladoc.com/download/for-parasites-ann- louise-gittleman_pdf. Accessed May 13, 2020. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Ann Louis Gittleman PhD, CNS • Referred to as the “great masqueraders”, parasites have been implicated in a whole host of seemingly unrelated conditions. – Fibromyalgia, myasthenia gravis, scleroderma, Syorgens Syndrome, lupus, peptic ulcer, rheumatoid and osteoarthritis, chronic fatigue and even cancer have been linked to parasitic infection • Parasites can also be the root cause of commonly experienced health problems including – Inability to lose or gain weight, , hypoglycemia, hypothyroidism, , constipation, diarrhea, bloating, vague and muscle aches, depression, hyperactivity, anemia and insomnia

[PDF] for Parasites - Ann Louise Gittleman - Free Download PDF. [PDF] for Parasites - Ann Louise Gittleman - Free Download PDF. https://ziladoc.com/download/for-parasites-ann- louise-gittleman_pdf. Accessed May 13, 2020. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Who is at Highest Risk?

• Those with a compromised immune system or who are already sick with another illness • Those who live or travel in tropical or subtropical regions of the world • Those who lack a clean supply of drinking water • Those who swim in lakes, rivers, or ponds where Giardia or other parasites are common • Those who work in childcare, work with soil regularly, or work in other contexts where you come into contact with feces on a consistent basis • Construction workers

Kinman T. Parasitci Infection. Healthline (webite) Sept 20, 2016. https://www.healthline.com/health/parasitic-infections#risk-factors. https://www.healthline.com/health/parasitic-infections Accessed May15, 2020

©2020 COPYRIGHT. ALL RIGHTS RESERVED Parasite Sources

• Water – About one-fourth of domestic households carry parasites in their water. About one-fifth of U.S. households supplied by surface water treatment plants will introduce such parasites as Giardia and Cryptosporidium in tap water. – Also, back country water (forest land – used to graze cattle in the high country – western part of the country) – wilderness outings. – Camping – no filter or chlorination – Consider micro-pure filtration

Parasites. Parasitetesting. https://www.parasitetesting.com/parasites. Accessed May 13, 2020.Camping World. Everpure Water Treatment System. https://www.campingworld.com/everpure- water-treatment-system (Date accessed: December 7, 2019) ©2020 COPYRIGHT. ALL RIGHTS RESERVED More on Cats

• Outdoor cats can come into contact with infected rodents and birds. This makes their owners more likely to contract toxoplasmosis, a of protozoa. • Toxoplasmosis can be very harmful for pregnant women and their developing babies. The infection is spread through cat feces. – If you’re pregnant, it’s important to have someone else clean the litter box daily.

Parasites. Parasitetesting. https://www.parasitetesting.com/parasites. Accessed May 13, 2020.Camping World. Everpure Water Treatment System. https://www.campingworld.com/everpure- water-treatment-system (Date accessed: December 7, 2019) ©2020 COPYRIGHT. ALL RIGHTS RESERVED Parasite Sources

• Pets – Certain pets particularly dogs and cats (especially outdoor cats) can transmit parasites such as hookworm, roundworm, and giardia, and intermittent stages of tapeworm by contact such as licking and kissing • Salmonella, too, can be passed from your dog to you, or vice versa. • Poor Hygiene: either the infected individual or through another (often picked up from food prep workers) • Rise in International travel • Food: Raw or undercooked foods: Undercooked pork, Sushi, etc. • Antiobiotic use: increased vulnerability through effect on microbiome Parasites. Parasitetesting. https://www.parasitetesting.com/parasites. Accessed May 13, 2020.Camping World. Everpure Water Treatment System. https://www.campingworld.com/everpure- water-treatment-system (Date accessed: December 7, 2019) ©2020 COPYRIGHT. ALL RIGHTS RESERVED Parasites

• Symptoms: diarrhea, constipation, irritable bowel, cramps, gas, bloating, bleeding, itching, poor digestion, malabsorption, weight loss • Monitor for dehydration with diarrhea • Can also cause: fatigue, allergies, muscle/joint pain, skin abnormalities/ sores/ dermatitis, headache, insomnia, nausea, dry cough, or lymph blockage

Parasites. Parasitetesting. https://www.parasitetesting.com/parasites.Camping World. Everpure Water Treatment System. https://www.campingworld.com/everpure-water- treatment-system . Accessed May 13, 2020 ©2020 COPYRIGHT. ALL RIGHTS RESERVED Parasite Questionnaire

1. Chronic fatigue for no apparent reason 19. Abdominal or pain/cramps 2. Swollen or achy 20. Mucus in nose that is moist or encrusted 3. Increased appetite, hungry after meals 21. Dark circles under the 4. Eat out at restaurants 22. Bowel urgency 5. Nervous or irritable 23. Skin problems, rashes, hives, itchy skin 6. Restless sleep/teeth grinding while asleep 24. Vertical wrinkles around mouth 7. Night sweats 25. Kiss pets, allow pets to lick your face 8. Blurry, unclear vision 26. Go barefoot outside the home 9. Fevers of unknown origin 27. Travel in 3rd world countries 10. Frequent colds, flu, sore throats 28. Eat lightly cooked pork/ salmon products 11. Recurrent feelings of unwellness 29. Eat sushi, sashimi 12. Constipation 30. Swim in creeks, rivers, lakes 13. Diarrhea alternating with constipation 31. History of parasitic infection 14. Thinning or loss of 32. Loose stools or diarrhea 15. Allergies, food sensitivities 33. Pale, anemic or yellowish skin 16. Irritable bowel, irregular bowel 34. Foul-smelling stools 17. Rectal, anal itching 35. Low back or pain 18. Bloating or gas 36. Indigestion, malabsorption

Parasite Questionnaire. Parasitetesting. https://www.parasitetesting.com/parasitequestionaire. Accessed May 13, 2020. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Parasite Prevention

• Keep your digestive system clean and clear is through regular daily elimination – Eat fiber-rich foods, stay hydrated, etc • Keep microbiome balanced, commensals abundance and diverse, and your immune system strong • Filter drinking water • Keep your pets healthy • Go back and review causes – and avoid them!

1. Templeton J, Lucas, McInnis L, et al. Parasites: The Health Threat No One Talks About. Your Health Keys. https://blog.unikeyhealth.com/parasites-health-threat-talks-but-will/. Published June 6, 2017. Accessed May 13, 2020. 2. Resnick L. Simple steps for avoiding infections from dogs and cats. Harvard Health Blog April 06, 2012 https://www.health.harvard.edu/blog/simple-steps-for-avoiding- infections-from-dogs-and-cats-201204064577. Accessed May 16, 2020. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Anti-parasitic Herbs

• Some Parasites are treated very effectively with medications, though some prefer herbal treatment as an alternative or to follow drug therapy. • Goldenseal: Increases immune action against pathogens and enhances bile secretion and liver/digestive functions. anti- diarrheal, anti-bacterial, anti-parasitic • Black Walnut: Shown to kill bacterial, parasitic, and yeast organisms • Sweet wormwood: artemisinin shown to kill intestinal parasites and worms. May have a role as a buster • Others: Clove, Cinnamon, Oregano, Neem, diatomaceous earth • Common to split herbals dosing treatments – 4 wks on, 2 off, 4 on again.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Anti-parasitic Specifics • A.D.P. (Biotics) – Oregano oil: anti- yeast, anti-fungal, antibacterial – 2-3 caps BID/TID for two weeks, then 1 tab 3 times/day – For Parasites: 2 weeks on, 10 days off, repeat. • Para Gard (IT): supports detoxification of microbial byproducts and supports immune and antioxidant defense – 1-3 caps 3 times/day – Contains: Grapefruit seed extract, berberine sulfate, black walnut, garlic, goldenseal, Jamica quassia, sweet wormwood – Parasites: 2-3 weeks on, 2 wks off, repeat. • Some would say to be sure to treat over a full moon • Milk bath: old folk remedy for tape worms • Biocidin: good for all dybiosis and biofilm • UniKey Protocol: (ParaKey, etc)

1. A.D.P.® (60 T). Biotics Research Corporation. https://www.bioticsresearch.com/node/1654. Published April 8, 2019. Accessed May 13, 2020. 2. Para-Gard®. Integrative Therapeutics, LLC. https://www.integrativepro.com/Products/Gastrointestinal/Para-Gard. Accessed May 13, 2020. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Sample Products

©2020 COPYRIGHT. ALL RIGHTS RESERVED Yeast Overgrowth

©2020 COPYRIGHT. ALL RIGHTS RESERVED Candida/Yeast

• Candida (or any yeast overgrowth) can cause an array of diseases such as immune reactivity, Irritable Bowel Syndrome (IBS), dermatitis, low energy, PMS, mood swings, “foggy brain” and other symptoms • Causes of Candida Overgrowth: • Increased use of antibiotics and oral contraceptives • High sugar and starch diets • Stress • Overuse of antibiotics • Chlorinated water • Toxic metals such as mercury weakens the immune system to allow for candida overgrowth • Book: The Yeast Connection – Dr Crook • Questionnaire

1. Crook WG. The Yeast Connection. New York, New York: Random House; 1986. 2. Janossy T. The Hidden Candida-Mercury Link. Radix.com https://oradix.com/candida-mercury/ Accessed May 15, 2020 ©2020 COPYRIGHT. ALL RIGHTS RESERVED Candida

• Overgrowth of (most common yeast) can be signified by a large number of skin problems. – Psoriasis – Inflammation – Rashes on various parts of the body – Atopic dermatitis –

Parasitic Organisms. https://webcache.googleusercontent.com/search?q=cache%3AY4xW-yGKqNEJ%3Ahttps%3A%2F%2Fwww.gdx.net%2Fcore%2Fsupplemental-education- materials%2FParasitic-Organisms-Chart.pdf. Accessed May 13, 2020. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Candida

• Candida albicans is closely linked with the activity of reproductive hormones in women. – Estradiol, one of the body’s main forms of estrogen, promotes the growth and the survival of C. albicans – therefore yeast associated with estrogen dominance issues (e.g. PMS, Fibroids)

About Candida albicans. http://www.yeastconnection.com/about_can_yeast.html. Accessed May 13, 2020. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Candida Key Symptoms • Bloating, gas, diarrhea, constipation, new sensitivities to commonly eaten foods • Fatigue, headache, depression, irritability, disorientation, dizziness, inability to concentrate • Sugar cravings, sensitivities to chemicals and perfumes, alcohol intolerance, increased susceptibility to the side effects of medications • Muscle and joint aches, sinusitis and recurrent colds, recurrent skin rashes • (In women), premenstrual syndrome (PMS), decreased libido, recurrent , vulvar itching and pain, IC • (In men), prostate and bladder infections

Candida Overgrowth Syndrome. WholeHealth Chicago. https://wholehealthchicago.com/2009/05/03/candida-overgrowth-syndrome/. Published June 4, 2018. Accessed May 13, 2020.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Dr. William Crook Candida Questionnaire http://yeastconnection .com/yeast.html

Do you have Yeast? http://yeastconnection.com/yeast.html. Accessed May 13, 2020. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Typical Candida Diet

• No sugar • No yeast • Limit starches • No artificial sweeteners or products • No vinegar, fermented foods • Choose vegetables (no starch or mushrooms) • Limit fruit • Choose proteins • Cold pressed oils • Avoid dairy, caffeine • Water • Use salt

The Candida Diet. The Candida Diet. https://www.thecandidadiet.com/. Accessed May 13, 2020.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Anti-fungal Support

• Caprylic Acid • Undecylenic acid (Calcium Undecylenate) • Pau D’arco Extract • Berberine • Olive Leaf Extract • Grapefruit Seed Extract • Oregano • Thyme • Goldenseal

©2020 COPYRIGHT. ALL RIGHTS RESERVED Caprylic Acid

• One of the three fatty acids found in coconut oil • Potent antibacterial, , and anti- inflammatory properties • Some scientists believe that caprylic acid is effective because it can break down the membranes of candida cells. • A procedure called oil pulling is sometimes used as a remedy for oral thrush. – Oil pulling involves swishing coconut oil in the mouth for 10 to 20 minutes at a time.

Omura Y. et al. Caprylic acid in the effective treatment of intractable medical problems of frequent urination, incontinence, chronic upper respiratory infection, root canalled tooth infection, ALS, etc., caused by asbestos & mixed infections of Candida albicans, Helicobacter pylori & cytomegalovirus with or without other microorganisms & mercury. Acupunct Electrother Res. 2011;36(1-2):19-64.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Caprylic Acid

• Found as magnesium caprylate • Dose depends on product - follow label instructions • Often found in combination ingredient products • Not recommended for women who are pregnant or breastfeeding. • Can sometimes cause stomach upset. • Can be problematic with coconut allergy.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Undecylenic Acid

• Provided by calcium undecylenate – A monounsaturated fatty acid which inhibits hyphae formation in yeast cells • Possesses antifungal properties, may assist with biofilm breakdown • Often included in combination products • Dose depends on product - follow label instructions • Often found in combination ingredient products • Not recommended for women who are pregnant or breastfeeding.

Shi D, et al. Antifungal effects of undecylenic acid on the biofilm formation of Candida albicans. Int J Clin Pharmacol Ther. 2016 May;54(5):343-53. doi: 10.5414/CP202460.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Monolaurin

• Also known as glycerol monolaurate (or lauric acid), a natural compound found in coconut oil and is known for its protective biological activities as an antimicrobial agent. – Also naturally found in human breastmilk, which contains the monoester of the fatty acid lauric acid. • Has a potential antifungal activity against C. albicans and can modulate the pro-inflammatory response of the host. – Supportive of immune in general • Take as directed, usually with meals

PMCID: PMC4924139Seleem D. et al. In vitro evaluation of antifungal activity of monolaurin against Candida albicans . PeerJ 2016; 4: e2148. Published online 2016 Jun 22. https://peerj.com/articles/2148/ doi: 10.7717/peerj.2148 Accessed May 15. 2020

©2020 COPYRIGHT. ALL RIGHTS RESERVED Sample Products for Yeast Overgrowth

©2020 COPYRIGHT. ALL RIGHTS RESERVED

• A yeast, but one with potential which has displayed anti-Candida properties in relevant research studies. – S. boulardii is a transient probiotic, meaning it does not take up residence within the gut. • S. boulardii has been shown to inhibit populations of Candida and deter them from establishing in the intestines. • May help to reduce the risk of Candida translocating from the digestive tract. • These effects occur because S. boulardii can secrete caprylic acid, an antifungal substance which is effective against Candida yeasts.

1.Ducluzeau, R. & Bensaada, M. Comparative effect of a single or continuous administration of Saccharomyces boulardii on the establishment of various strains of Candida in the digestive tract of gnotobiotic mice. Annales de microbiologie. (Inst. Pasteur). 133: pp: 491-501 2.Berg, R. et al. Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomcyes boulardii. J Infect Dis. 1993,Nov;168(5):1314-8. 3.Murzyn, et al. Capric Acid Secreted by S. boulardii Inhibits C. Albicans. August 2010, Plos One, Vol. 5. Issue 8. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Saccharomyces boulardii dosing

– Typical does is 1 capsule twice a day (morning and evening) – follow label instructions – Can sometimes cause constipation at high doses

©2020 COPYRIGHT. ALL RIGHTS RESERVED Probiotics/Prebiotics

• Lactobacillus acidophilus NCFM shown in studies to stimulate the production of antibodies to C. albicans antigens. • Some prefer to avoid prebiotics such as inulin and Fructooligosaccharides (FOS) as these may feed the yeast and work against the supportive treatment

1. Miyazima TY et al. Cheese supplemented with probiotics reduced the Candida levels in denture wearers-RCT. Oral Dis. 2017 Oct;23(7):919-925. doi: 10.1111/odi.12669. Epub 2017 May 16. 2. Wagner R.D., Pierson, C., Warner, T., Dohnalek, M., Hilty, M. and Balish,E. (2000). Probiotic effects of feeding heat-killed Lactobacillus acidophilus and Lactobacillus casei to Candida albicans colonized immunodeficient mice. J. Food Prot. 63(5):638-644

©2020 COPYRIGHT. ALL RIGHTS RESERVED Probiotics for Candida

• GG (GI tract) – 69% decreased risk of gastrointestinal Candida colonization in preterm infants (P=0.01); significantly reduced enteric Candida population in infants who were colonized • Lactobacillus reuteri DSM 17938 (oral thrush) – In elderly nursing homes residents, use of probiotic lozenges (10^8 CFU twice daily) for 12 weeks, promoted a significant reduction in the prevalence of Candida counts in both saliva and plaque when compared with placebo

1. Kraft-Bodi E et al. Effect of Probiotic Bacteria on Oral Candida in Frail Elderly. J Dent Res. 2015 Sep;94(9 Suppl):181S-6S. doi: 10.1177/0022034515595950. Epub 2015 Jul 22. 2. Manzoni P et al. Oral supplmentation with Lactobacillus casei subspecies rhamnosus prevents enteric colonization by Candida species in preterm neonates: a randomized study. Clin Infect Dis. 2006 Jun 15;42(12):1735-42. Epub 2006 May 4.

©2020 COPYRIGHT. ALL RIGHTS RESERVED Probiotics for Candida

• Lactobacillus rhamnosus Lr-32 (oral thrush) – Denture wearers who received cheese supplemented with Lactobacillus rhamnosus Lr-32 (n=20) 20g daily for 8 weeks had significantly reduced mean levels of oral Candida spp. (Tukey, P<0.05) compared to control cheese • Streptococcus salivarius M18 (oral) – 75 subjects given 4 different doses for 28 days - it appears that application of probiotic strain M18 offers potential low impact alternative to classical antibiotic prophylaxis.

1. Miyazima TY et al. Cheese supplemented with probiotics reduced the Candida levels in denture wearers-RCT. Oral Dis. 2017 Oct;23(7):919-925. doi: 10.1111/odi.12669. Epub 2017 May 16. 2. Burton J et al. Persistence of the Oral Probiotic Streptococcus salivarius M18 Is Dose Dependent and Megaplasmid Transfer Can Augment Their Bacteriocin Production and Adhesion Characteristics. Published online Jun 13, 2013 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0065991 doi: 10.1371/journal.pone.0065991 Accessed May 15, 2020

©2020 COPYRIGHT. ALL RIGHTS RESERVED Woman’s Health Probiotics

• Lactobacillus Rhamnosus GR-1 and Lactobacillus Reuteri RC-14 Probiotic • A combination of Lactobacillus rhamnosus GR- 1® and Lactobacillus reuteri RC-14® (strains used in research) to promote healthy vaginal colonization. – Helps restore and maintain a healthy balance of vaginal microflora and yeast

1. Reid G,, et al. 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 2003;35:131–4. 2. McMillan A, Dell M, Zellar MP, et al. Disruption of urogenital biofilms by lactobacilli. Colloids Surf B Biointerfaces 2011;86(1):58–64. 3. Gardiner GE, et al. Oral administration of the probiotic combination Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 for human intestinal applications. International Dairy Journal 2002;12:191–6. 4. Reid G, Beuerman D, Heinemann C, Bruce AW. Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immunol Med Microb 2001;32:37–41. ©2020 COPYRIGHT. ALL RIGHTS RESERVED Sample Products

©2020 COPYRIGHT. ALL RIGHTS RESERVED UP NEXT…

Bacterial Overgrowth

Top View