Pod Insights This Podcast Will Kill You Ep 188 Candida yeast: Here, there, and everywhere About this episode None of us are ever truly alone. Our bodies are home to untold numbers of microbes, chilling on our skin, in our guts, throughout our respiratory tract, inside our bellybuttons, under our fingernails, and beyond. For the most part, we live in harmony with these critters, never giving them a second thought. But occasionally, they may grow a bit too friendly, taking advantage of our hospitality to grow and spread with abandon. Candida yeasts are especially fond of this tactic, leading to millions of infections around the globe each year, many of which can cause significant illness or even death. In this episode, we explore the characteristics of these yeasts that make them so prone to overgrowth, how severe infections can develop, and why one of medicine’s greatest achievements may have helped usher in this new fungal era.
Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAu
See omnystudio.com/listener https://omnystudio.com/listener for privacy information.
Transcript 13,586 words · 7 speakers
0:01 Speaker 00 This is exactly right.
0:06 Speaker 01 What is one thing many of us deal with every single day but rarely talk about? Dry hands. Whether you frequently wash your hands or deal with harsh weather, your hands can be left feeling dry, rough, cracked, and even uncomfortable. That's where O'Keefe's Working Hands Hand Cream comes in to help. The fast-absorbing formula goes on smoothly and it won't leave behind a greasy residue, so you can get back to your busy day without ever missing a beat. And because a little will go a long way, O'Keefe's Working Hands Hand Cream is effective, dependable, and economical, too. Whether you're dealing with harsh weather outside, demanding work, or everyday wear and tear, O'Keefe's Working Hands works just as hard as you do. So keep your hands hydrated, smooth, and feeling comfortable all season long.
0:51 Speaker 01 Visit okeefescompany.com today. That's O-K-E-E-F-F-E-S company dot com for guaranteed relief. O'Keefe's Working Hands. Yeah, it works.
1:03 Speaker 02 Hey, I'm Niall Rogers. This fall, I'll be driving across the country, meeting some of today's coolest and most fascinating artists. We'll explore the stories before the moments that changed everything. Because every musician remembers the moment where it all began. Experience Before the Moment, a Lincoln original series on the iHeartRadio app, YouTube, or wherever you get your podcasts.
1:35 Speaker 03 Let me take you back to when I was a weird, nerdy 14-year-old. I'd recently started menstruating and was incredibly self-conscious about managing my periods at school. The popular girls would congregate in the school bathroom, so they'd hear the unzipping of my bag and the crinkle as I unwrapped sanitary products from their packaging. I was terrified about what gossip would be spread around school if people found out that I was on my period. I made the decision to avoid changing my sanitary products at school. This created a lovely, warm, moist environment for yeast, so it's no surprise that I got a yeast infection or thrush. If you have not had the pleasure, it's like an infected horsefly bite.
2:18 Speaker 03 It's an incessant itch that is constantly screaming for attention. I couldn't sleep, it hurt to pee, I couldn't concentrate on anything except for the pain of the itch. This, coupled with being a teenager, with hormones coursing through my body, the shame and self-loathing of my poor decision, made this a really distressing time. To add to my humiliation, I had to tell my GP about my symptoms, but I lacked the polite vernacular to do so. I eventually stammered that I had an itch at the front of my bum, and the GP took pity on me, and my mum was able to take over the consultation.
3:00 Speaker 03 I was asked no further questions and no invasive tests were performed. I was given a prescription for Canistin, and this was the first time I had ever used a Pessary and had no idea whether I was inserting correctly. However, I recovered and became scrupulous about my vaginal health and changed my sanitary products at least every four hours as recommended. Fast forward about ten years, I'm in a sexual relationship and I get the itch. I assume it's thrush and get Canistin over the counter at the pharmacy and then carry on with my day. The thrush clears up for a while, but then it comes back. So I called the GP and they tell me to go to the sexual health clinic.
3:44 Speaker 03 To do this, I have to take annual leave to travel there in the opening hours. Even then, they only accommodated walk-ins, so I may not have been seen. If these barriers are not enough, I was also extremely embarrassed with the whole idea of going to a sexual health clinic. Eventually, I saw a GP who gave me a swab and confirmed I did have recurrent thrush. My partner at the time laughed and told me that thrush was no big deal, which is probably because he couldn't catch it.
4:16 Speaker 03 Because my thrush was recurrent, the GP gave me a blood test for diabetes which came back negative. There was no obvious cause, so I fell through the cracks a little bit. The GP had never asked about my environment. If they had, we probably would have figured out the cause pretty quickly. In the office, my desk was positioned directly underneath the aircon, and I really feel the cold, so the office administrator had very kindly given me a little heater to put underneath my desk. I like to have it snug between my knees, which created a really lovely warm environment for myself and also for the yeast. At the time, I didn't put two and two together.
5:01 Speaker 03 I just carried on in discomfort for the next few months with the added expense of Caniston on my regular shopping list. There were other knock-on effects: my sleep suffered, my relationship suffered, my partner at the time really struggled with the reduction of intimacy, so on the nights when saying no wasn't worth the drama, I would spread my legs, close my eyes, and think of England, as the saying goes. For those who haven't had the pleasure, it feels like having sandpaper shoved inside that horsefly bite I described earlier. Several years later, I'm happily single, I work from home and can control my environment, and I am thrush-free.
5:44 Speaker 03 I found thrush to be extremely isolating, and I hope that if anyone can relate to my story, that they find comfort that they are not alone. Thank you very much for listening.
6:42 Speaker 04 You know, I feel like that story really, it exemplifies some of the shame that's surrounding things like yeast infections.
6:52 Speaker 01 Yeah, yeah. I feel like no one wants to talk about yeast infections.
6:56 Speaker 04 Right.
6:57 Speaker 01 But they're so common.
6:58 Speaker 04 I was gonna say, like, literally every person.
7:00 Speaker 01 With a vagina.
7:01 Speaker 04 With a vagina has had a yeast infection.
7:02 Speaker 01 Seventy-five percent, actually.
7:04 Speaker 04 Okay, almost everyone. That is pretty much close to everyone. Yeah.
7:07 Speaker 01 Yeah.
7:08 Speaker 04 Yeah.
7:09 Speaker 01 Thank you so much for sharing your story with us and everyone listening. We really appreciate it.
7:15 Speaker 04 Yeah, thank you. Thank you. Hi, I'm Erin Welsh.
7:18 Speaker 01 And I'm Erin Omen Updike.
7:20 Speaker 04 And this is This Podcast Will Kill You.
7:22 Speaker 01 Welcome to yeast infections.
7:25 Speaker 04 And, I mean, yeast infections.
7:27 Speaker 01 It's broader.
7:28 Speaker 04 Yeah, well, I feel like, but it's all yeast or yeast-like. And so, it's, yeah.
7:34 Speaker 01 Yeah.
7:35 Speaker 04 Candida.
7:36 Speaker 01 Candida.
7:37 Speaker 04 Yeah. And not just Candida albicans, Candida auris, Candida.
7:40 Speaker 01 All the Candidas.
7:41 Speaker 04 Those are the only two I know right now.
7:42 Speaker 01 Don't worry.
7:43 Speaker 04 At this point in our conversation. I can't believe we haven't done this.
7:48 Speaker 01 I can.
7:49 Speaker 04 You candida?
7:50 Speaker 01 Our list is simply too long.
7:52 Speaker 04 Oh, that's good. No, it wasn't.
7:55 Speaker 01 Our list is long and, you know, we're doing it now. That's all we can say.
8:03 Speaker 04 We're doing it now. I learned a lot. We're about to learn some more.
8:06 Speaker 01 Yep.
8:07 Speaker 04 And we're about to tell you about a recipe for our.
8:11 Speaker 01 Quarantini.
8:12 Speaker 04 Quarantini.
8:13 Speaker 01 Or placebo-rita today.
8:14 Speaker 04 Placebo-rita. Yeah, actually, it is. You can make it a quarantini if you want.
8:17 Speaker 01 Sure.
8:18 Speaker 04 It's called a candid shot.
8:21 Speaker 01 A candid shot.
8:22 Speaker 04 Yeah.
8:23 Speaker 01 The candid shot or just a candid shot?
8:24 Speaker 04 Well, the only reason I was thinking a candid shot is because candida, and then what happens to that a, we just move it over. But the candid shot also works.
8:33 Speaker 01 Look at you and your grammar. I like it. A candid shot.
8:35 Speaker 04 Thank you. A candid shot is fairly simple. It is like rose soda and rhubarb.
8:41 Speaker 01 Mm-hmm. I was gonna say, like. You just stand there and someone takes your picture.
8:45 Speaker 04 Sorry. That wouldn't be candid.
8:47 Speaker 01 No, you're right.
8:51 Speaker 01 Anyways, you can find the full, very complicated recipe for that pussy burrito. And if you want to add alcohol, a quarantini on our website, thispodcastwillkillyou.com and our socials. Are you following us on socials? Erin's making videos of these drinks.
9:06 Speaker 04 Poor, poor videos. Yeah, not very good, but they exist.
9:10 Speaker 01 We're trying, you know, new things.
9:12 Speaker 04 Things.
9:14 Speaker 01 Instagram, Tik Tok, Facebook.
9:16 Speaker 04 Website.
9:17 Speaker 01 Website.
9:18 Speaker 04 Thispodcastwillkillyou.com. Transcripts, links to merch, links to bookshop.org affiliate account, links to Goodreads list, links to music by Bloodmobile, the sources for each and every one of our episodes. There's also embedded YouTube videos there. So if you check out our.
9:33 Speaker 01 Oh, you've been doing that, Erin. Look at you.
9:36 Speaker 04 Sometimes I'm a little bit late because I have to wait for the day that they publish. It doesn't matter. They're there. And some other things, a contact us form. Thank you, everyone who has submitted your story for a firsthand account. Using our firsthand account form.
9:51 Speaker 01 Just know it could be years before we contact you, but we read them all.
9:54 Speaker 04 But we do read them all. Yeah, yeah, yeah. I think that's it.
9:58 Speaker 01 That's it. You did a great job.
10:00 Speaker 04 Thank you.
10:01 Speaker 01 Do you want to hear about the biology of Canada?
10:03 Speaker 04 Of course I do.
10:04 Speaker 01 Let's take a break and get into it. What is one thing many of us deal with every single day, but rarely talk about? Dry hands. Whether you frequently wash your hands or deal with harsh weather, your hands can be left feeling dry, rough, cracked, and even uncomfortable. That's where O'Keefe's Working Hands Hand Cream comes in to help. The fast absorbing formula goes on smoothly and it won't leave behind a greasy residue. So you can get back to your busy day without ever missing a beat. And because a little will go a long way, O'Keefe's Working Hands Hand Cream is effective, dependable, and economical, too. Whether you're dealing with harsh weather outside, demanding work, or everyday wear and tear, O'Keefe's Working Hands works just as hard as you do.
10:48 Speaker 01 So keep your hands hydrated, smooth, and feeling comfortable all season long. Visit okeefescompany.com today. That's O K E E F F E S company.com for guaranteed relief. O'Keefe's Working Hands. Yeah, it works.
11:04 Speaker 05 Right now, you can save 70% on Simply Safe home security. Traditional security systems only alert you after a break-in has already happened, and that's too late. Simply Safe is changing that.
11:18 Speaker 06 Stop. This is Simply Safe. You're being monitored and recorded. I'm requesting police dispatch.
11:23 Speaker 05 Using the Outdoor Camera Series 2 and Advanced AI Alerts, our live US-based agents identify potential threats on your property and help deter them. So the intruder never gets into your house. The break-in never happens. Because we don't just alert, we stop crime before it starts. Simply Safe monitoring and deterrence plans start around $1 a day with no long-term contracts. Order today to get 70% off a new system with professional monitoring. Save now at simplysafe.com/iheart. Simply Safe, ahead of crime in real time. Outdoor deterrence plans start at $49.99 a month. Visit simplysafe.com/licenses for alarm license information.
12:05 Speaker 01 Hello, hello. I'm Malcolm Gladwell, host of Smart Talks with IBM. I spoke with IBM's Ana Paula Acees about what digital sovereignty actually means in the age of AI.
12:15 Speaker 04 AI now moves from somebody operating a system to the technology actually making decisions. So you have to have a much better visibility of what AI is touching, data it is accessing, and where.
12:32 Speaker 01 Hear the full conversation wherever you get your podcasts.
12:47 Speaker 01 So the star of today's show is a fungus. And as we've learned in previous fungal episodes, fungi tend to be a little bit complicated.
12:58 Speaker 04 They do, yeah.
12:59 Speaker 01 They really do. And in the case of Canada, often people cite it as a yeast, right? We think yeast infection. And a yeast is a single-celled fungus, right? Like the kind of yeast that you use for bread. But Canada also exists as A filamentous mold with its little hyphae or sometimes pseudo hyphae branching out.
13:21 Speaker 04 Okay.
13:21 Speaker 01 So it's really quite multifaceted. And it might not be surprising that in part because of that, Candida can cause a really wide range of potential infections, not just vaginal yeast infections. There are several different species of Candida that cause infections in humans. The most common of which is Candida albicans. But there are, I think there's a push to group all of the other ones as like non-albicans Candida.
13:48 Speaker 04 Hmm.
13:49 Speaker 01 Or non, yeah, N A C, N A C Y, non-albicans Candida yeast anyways.
13:55 Speaker 01 And these actually, some of them have been growing in abundance and posing a growing concern to infectious disease specialists and in public health officials and infection preventionists in hospitals.
14:06 Speaker 04 Well, because that's what I was wondering. So why would you, like, are all non-albicans Candida as pathogen, like equally pathogenic and problematic?
14:16 Speaker 01 All of them tend to be more apt to resistance, which is one of the big concerns about them. Yeah.
14:24 Speaker 04 Very interesting.
14:25 Speaker 01 Yeah. So the kind of most notable ones, and there are more than these two, but kind of the most notable ones are Candida auris, and we'll talk more about that later. And then what used to be called Candida globrata, but what is now has been reclassified as Naca seumycis globratus.
14:43 Speaker 04 Okay.
14:44 Speaker 01 And I think that's also part of why they're saying, call everything non-albicans, because it's like they've been renaming some things, which is important, but also gets confusing.
14:55 Speaker 04 Yeah, yeah.
14:56 Speaker 01 And then also Candida parasillosis. So that's the other one.
15:01 Speaker 04 Sure.
15:02 Speaker 01 And all of three of these do tend to have more resistance to antifungals than Candida albicans. And so we'll talk a little bit more about them a little bit, and you can ask questions, and I might not have the answers. But for most of this episode, especially for the like pathogenicity part of things, I'm going to focus on Candida albicans. It is by far the most common, something like 90% of us are colonized right now as we speak on our skin, or in our mouths, or in our vaginas, or in our guts, because it can live there too. So Canada is or causes what we often call an opportunistic infection, meaning that when the opportunity arises, it will cause infection.
15:43 Speaker 01 And when it does not arise, it simply coexists with us.
15:48 Speaker 04 Maybe even beneficial.
15:50 Speaker 01 Maybe, though I didn't research that at all.
15:53 Speaker 04 That's okay. I have a paper.
15:54 Speaker 01 Love it. And it lives not just on our skin and in our mucous membranes, but also in the environment and mostly just hangs out there a little bit unobtrusive until it becomes a problem. I think of it as just getting too big for its britches and deciding to take over the place. Writing executive orders and all of the judges and other lawmakers are nowhere to be found. Can't keep it in check. Just kidding.
16:21 Speaker 04 I guess this is fine for me to take over. No one's here, like.
16:26 Speaker 01 Yeah, no one else is here. I'll just, I'll just move in.
16:29 Speaker 04 Yeah.
16:29 Speaker 01 So let's talk about what kinds of problems it can cause because it's really varied. And not all Canada infections are created equal. There are broadly two big categories of candidal infections. There's mucocutaneous infections, so skin and mucous membranes. And then there are systemic infections. You can probably guess which one is more severe. The most, I don't even know if this is, I don't know if it's true to say the most common, but probably like the thing that I certainly I think about and that most people probably think about with Canada is a vaginal infection or vulvovaginal candidiasis. And we kind of said this already, but something like 75% of people with a vagina
17:10 Speaker 01 will have candidiasis at least once in our lives. 6 to 10% of us may have recurrent vulvovaginal candidiasis, which is usually defined in the literature as more than four per year with resolution of the symptoms in between each episode.
17:28 Speaker 04 Okay, not just like persistent, like so, I mean, okay, that is the chronic part. Are there, how long, oh, okay, never mind. Am I getting ahead of things already?
17:37 Speaker 01 Yeah, you're asking a lot of questions.
17:39 Speaker 04 I'm like, how long does a yeast infection last? How long does treatment, how long does it take to resolve things? How long do, does it, yeah, does it ever self-resolve?
17:47 Speaker 01 Yeah, certainly can, certainly can self-resolve. How long it lasts just totally depends on the person and their immune system. And what kind of treatment they get, if they get treatment. Treatment depends on the situation. It can be topical, so sometimes we use like vaginal suppositories or vaginal creams, or it can be oral. And that's usually a shorter course unless it's a more resistant strain or you have recurrence or something like that. Then sometimes you need a prolonged course of oral antifungals.
18:15 Speaker 04 Okay, one, real quick, one question.
18:17 Speaker 01 Okay.
18:18 Speaker 04 So for the people who have recurrent yeast infections, what is driving that recurrence?
18:23 Speaker 01 Isn't that a great question?
18:25 Speaker 04 We don't know.
18:26 Speaker 01 We don't know.
18:27 Speaker 04 Okay.
18:27 Speaker 01 Yeah. What I can tell you a little bit about, since I haven't even mentioned it yet, is what the symptoms of a vaginal yeast infection are.
18:34 Speaker 04 Sorry. I just got excited.
18:37 Speaker 01 I love it, Erin. Don't, don't ever apologize for your excitement. But again, most of us is probably-
18:43 Speaker 04 For other things, yes.
18:48 Speaker 01 Most of us have probably experienced this. We can see inflammation. We see a white, chunky, cheesy kind of cottage cheese discharge. Itching, burning, pain. And this is an infection that is very easy for people to dismiss. And by people, I mean the people not experiencing it. But it has a substantial economic and morbidity burden. And we'll talk a little bit more about that later on in this episode.
19:16 Speaker 01 The risk factors for like, why do people get yeast infections and some people don't? Or when does someone get a yeast infection? Risk factors can include poorly controlled diabetes. Sometimes we see associations with sexual activity, but it's not considered by any means a sexually transmitted infection. Because again, this is like a commensal.
19:34 Speaker 04 Right.
19:35 Speaker 01 We also can see an increase in cases with increased estrogen states, so like during pregnancy and things. But by far, the most common is antibiotic use.
19:46 Speaker 04 Yeah.
19:47 Speaker 01 And that's true for a lot of candidal infections, not just vulvovaginal infections.
19:52 Speaker 04 Right, right.
19:53 Speaker 01 But it's not just the vagina. Our other mucous membranes can often get infected. So we can see oral or esophageal candidiasis, which at least in the US, we often call thrush. And I think that they call thrush like a variety of candidal infections in other countries, too.
20:10 Speaker 04 Yeah.
20:11 Speaker 01 Um, but that is when you get infection of the tongue, the oral mucosa, the gingivitis of your gums, or your throat or esophagus. And you usually will see this kind of off-white, yellowish. It can almost be like, almost so dark that it looks kind of brownish or blackish. Just depending on like how long it's been there and things, but this plaque that forms in the mouth or in the throat.
20:34 Speaker 04 Yep.
20:34 Speaker 01 Most of the time with these infections, we see them with some type of immunocompromising condition. So something like HIV/AIDS or chronic steroid use, including, yes, inhaled corticosteroids. If you're not rinsing your mouth, and that's why you're supposed to rinse your mouth after you use like a inhaler.
20:52 Speaker 04 Interesting. Okay, okay.
20:54 Speaker 01 Or conditions that cause like a reduction in saliva, which is going to help to wash out the yeast that's in your mouth and keep it moving.
21:01 Speaker 04 What would that, what reduces saliva?
21:03 Speaker 01 Oh, something like Shogren syndrome, which is quite rare. But then there's other things that, I don't know, other specific conditions where people might have less saliva. Or people who wear dentures, I think, too, are at higher risk of oral candidiasis.
21:16 Speaker 04 Okay.
21:16 Speaker 01 But we can also see it on our skin or in our nails. We can get intertrigo. So like in the skin folds, maybe say axilla, groin, diaper rash for babies. You can get it on the penis. We call that balonitis. You can also get it on the nails. So either with like an ingrown nail. So we call that perennitia or onychomycosis, which is like the nail infection.
21:40 Speaker 04 Is that like on top of your nail or under your nail? Or like, how does that happen?
21:44 Speaker 01 It's like within the nail itself.
21:46 Speaker 04 Within the nail itself.
21:47 Speaker 01 Yeah, yeah.
21:48 Speaker 04 Okay.
21:48 Speaker 01 Yeah. It's here, it's there, it's everywhere. So given the right set of circumstances, it can absolutely flourish. And sometimes it can really go too far and cause a systemic or invasive infection inside of our bodies. The most common and most serious of these invasive candidal infections is called candidemia, which is a bloodstream infection. So yeast growing in our bloodstream. And this has a mortality rate of 30 to 40% depending on how you calculate it. And that's today, and that's in high-income countries.
22:23 Speaker 04 And that's with all the treatments available?
22:25 Speaker 01 Exactly. Yep.
22:27 Speaker 04 Wow.
22:29 Speaker 01 And part of that is because of just how hard it is to diagnose and treat these infections, especially once they've gotten into our bloodstream, but also because the vast majority of people who end up with a bloodstream infection are very sick to begin with. So we see this really commonly in things like ICUs, when people are already, you know, their immune systems are kind of at their limit and things like that. Once someone has an invasive candidal infection, they can end up with a number of other places that this candida infects thereafter. So you can get an infection in the eye, and it can cause candida endophthalmitis, which can potentially cause permanent blindness.
23:13 Speaker 01 It can go into the heart and cause endocarditis, so infection of the heart and the valves of the heart.
23:18 Speaker 04 Okay.
23:19 Speaker 01 It can get into the central nervous system, and we see this commonly in premature newborns. Something like 15 to 20% of the time, if a preemie ends up with invasive candidiasis, it will end up in their central nervous system, so with a meningitis or an encephalitis. I know. And then, especially after surgeries or other like abdominal procedures, people can get abdominal candidiasis, and that can result in like a fungal abscess or can sometimes infect the liver or the spleen. And in those cases, can sometimes cause a really prolonged infection that's really hard to treat.
23:53 Speaker 04 Do we have a more granular answer as to how this happens than there's a breakdown in immunosuppression and things just sort of spill over?
24:03 Speaker 01 It's a good question, not, not a super more granular one than that.
24:07 Speaker 04 Okay.
24:08 Speaker 01 There's always, I mean, almost always, there's going to be some, I say almost just to hedge, but realistically, there's always going to be some kind of like precipitating events, right? Whether it's some other infection, whether it's, you know, a bone marrow transplant, a solid organ transplant, you're on immunosuppressive drugs.
24:25 Speaker 01 Have, you know, HIV AIDS, like you're born with an immunodeficiency. So many potential conditions that lead someone to be more susceptible. And then it's like those right set of circumstances. The other thing that's very commonly predisposes someone to an invasive infection, especially a bloodstream infection, would be having indwelling lines. So if you have ports, if you have catheters, as we'll see, Candida forms biofilms very easily. And so they can colonize and form a biofilm on those indwelling lines and then put you at risk for invasive infection because it's just bopping off little yeasties from the biofilm.
25:04 Speaker 04 I feel like, so on this podcast, we have talked about a few other opportunistic pathogens that tend to just hang out and then crop up when something is a little bit out of balance. There's dysbiosis, whatever. And I, do we know why Candida rather than Staph aureus? Or why Candida rather than strep? You know, like, what is that deciding factor?
25:29 Speaker 01 I don't, well, I don't think it's always an either or.
25:32 Speaker 04 Sure, of course not, yeah.
25:34 Speaker 01 But yeah, I don't, I don't know. It's a good question. I mean, and it could be any of those. So it might just depend on that individual. What is their skin more colonized with? What do they happen to have on their bodies? What other antibiotics are they being exposed to? What happens to gain that foothold to begin with? Or what other, you know, because our immune systems respond to bacteria and to fungi in different ways. So what type of immunocompromising condition do you have? And does it leave you more susceptible to fungus? Because your immune system's just not as good at getting at that fungus versus a bacteria or something like that?
26:10 Speaker 04 Yeah, yeah.
26:10 Speaker 01 Are you already on all the antibiotics possible? And so you've killed all those and now only the yeast are left?
26:16 Speaker 04 Yeah, yeah.
26:18 Speaker 01 And as a fungus, Candida is already, in some ways, kind of harder for us to fight off compared to some bacteria because it's a eukaryote rat, right? So it's, it's a little bit closer to us. So it's harder for us to have antifungals. It's harder for our body to recognize it sometimes. However, Candida is also special and has quite a number of virulence factors that facilitate its ability to infect us and cause disease. For one thing, it can do that switching thing that I mentioned at the top. It can exist as a yeast or as this filamentous hyphae form, depending on its environment. And this allows it to disseminate widely when it's a yeast, right?
26:59 Speaker 01 It's really hardy, it can exist in the environment, it can beep bop bop between people. And then it allows it to invade through our epithelial barriers when it's in its hyphae form. And then that also allows it to evade a lot of our immune responses.
27:14 Speaker 04 Okay, so the hyphae form does impact our immune, like its immunogenicity or something, detection?
27:20 Speaker 01 Majorly, majorly. And so it's really the hyphae form that we tend to see that that ends up being the reason that we have invasive disease.
27:28 Speaker 04 And so are all Candida albicans individual, you know, cells or whatever capable of this transformation?
27:36 Speaker 01 As far as I know, yes. And there are differences. And it does seem like the switching part of it is what makes them so good at causing disease, because when you breed strains that are only hyphae or only yeast, they're not quite as good. But in general, they all can do both. They're quite adept like that. Candida also has a bunch of proteins that we call adhesins, which I feel like we've talked about this, who knows on what episode. But they're basically sticky proteins that allow it to make these biofilms and to colonize places like our skin and mucous membranes and also things like catheters, pick lines, like all of these lines that especially if someone is already ill and in the ICU, they usually have quite a lot of lines.
28:21 Speaker 01 And a biofilm, for anyone who's forgotten the glory that is biofilms, they're these really complex assortments of a bunch of different microorganisms that end up forming their own protective barrier, this little extracellular matrix that completely blocks our immune response from accessing them, which means that they can continue budding off these little yeasties or having their little filamentous forms just kind of Creep out and go invade deeper into our bloodstream, for example.
28:51 Speaker 04 Where did we, was it Legionnaires' disease where we talked a lot about?
28:54 Speaker 01 Definitely talked about them.
28:55 Speaker 04 Okay.
28:56 Speaker 01 Legionnaires', but something since then too, because that was a long time ago, but I can't remember.
29:00 Speaker 04 Yeah.
29:00 Speaker 01 Can't remember what it was. Someone else, do you remember?
29:03 Speaker 04 What is it?
29:04 Speaker 01 Have a better memory than us. But lastly, they also have a bunch of enzymes that they can secrete these, this fungus to help break down our endothelial cell barriers and damage our cells and hide from our immune system. And what's so fascinating is that part of the way that Canada does this is actually by recognizing some of our metabolic cues. So they're sensing what's going on in their environment, AKA in our bodies, and changing the way that they grow, changing the structure of their own cell wall. They are just really, really well adapted to our human bodies.
29:43 Speaker 01 And probably the two biggest challenges when it comes to dealing with candidal infections, especially the severe ones, but even, you know, mucocutaneous infections, which I'm not saying those are not severe, just in comparison to bloodstream infections. It's diagnosis and treatment. And the diagnosis of candida is really challenging, in part because the gold standard is to grow it in culture. And these grow really slowly. They take a really long time to grow in culture, and our culture methods are imperfect. So if you have, say, a low abundance, you might get negative cultures, even though you have plenty of yeast growing in your body.
30:23 Speaker 04 Well, and then how do we, because it's a commensal, and it's on, you said ninety, over ninety percent of people, how do we know whether detection of candida is a problem, or like regular growth or overgrowth?
30:37 Speaker 01 Great question. So yeah, you can have false positives and false negatives, both directions, right? Depending on exactly what site you took it from, depending on how you took the samples. In general, though, it does not belong in our blood. So if Canada is going from a blood sample.
30:52 Speaker 04 Of course.
30:53 Speaker 01 But you're right. If it's from like a skin sample, is it overgrowth or is it not? And some of that comes down to like clinical diagnosis as well, too. What do things look like and stuff like that?
31:01 Speaker 04 What are your symptoms? Are you experiencing discomfort?
31:04 Speaker 01 Exactly, exactly. There are PCR methods and things, but they're not always available. And then treatment is hard in part because of the toxicity of a lot of drugs that we use and because of increasing antifungal resistance.
31:19 Speaker 04 Yeah.
31:21 Speaker 01 Yep. Uh, that's it. I could talk a little bit more about the details of the treatment, but it's, it's a little bit boring and niche, so.
31:28 Speaker 04 Well, maybe there, there are times when I talk about treatment in the history. And so maybe then we can figure out if there's some.
31:34 Speaker 01 Questions. Yeah.
31:35 Speaker 04 There are gaps. Yeah.
31:36 Speaker 01 So tell me, Erin, about the history of this little fungus, won't you?
31:40 Speaker 04 I will. I will.
31:43 Speaker 01 Dry hands can be uncomfortable and frustrating, especially when frequent hand washing, changing weather and everyday wear and tear take their toll. O'Keefe's Working Hands is here to help keep dry hands feeling hydrated and comfortable. O'Keefe's Working Hands creates a soothing barrier on the skin that locks in moisture and prevents further dryness. It's concentrated and non-gracey and you start to feel relief in one use. Go to okeefescompany.com to get yours today. That's O-K-E-E-F-F-E-S company.com for guaranteed relief. O'Keefe's Working Hands. Yeah, it works.
32:14 Speaker 05 Right now, you can save 70% on Simply Safe home security. Because what a break in really costs isn't your home or your valuables. It's the feeling that your home stopped being safe. That's why Simply Safe doesn't wait for danger to reach your family. We help stop it before it gets close with not just one, but three layers of protection. One, preventing threats outside with smart AI cameras and live US-based agents who intervene to deter intruders before they break in. Two, sounding the alarm at points of entry. And three, agents requesting emergency response when needed. Three layers, all working together to keep your loved ones safe. Plus, you control your privacy and recordings. And with the 60-day money-back guarantee, you can try us risk-free. Monitoring a deterrence. Plans start around a dollar a day.
32:58 Speaker 05 Order today to get 70% off a new system with professional monitoring. Save now at simplysafe.com/iHeart. SimpliSafe, ahead of crime in real time. Outdoor deterrence plans start at $49.99 a month. Visit simplysafe.com/licenses for alarm license information.
33:15 Speaker 05 Your business operates under pressure and you need control of your data. But IBM research shows only 9% of companies have real oversight of their technology. IBM's open hybrid cloud approach is designed to give you visibility with built-in governance tools, data sovereignty, and compliance reporting. It's another way IBM helps you stay in control of your data. Let's create smarter business. IBM. Visit ibm.com to learn more.
33:59 Speaker 04 Modern society.
34:04 Speaker 01 I simply love when episodes start like this, Erin. I just love it. Keep going.
34:08 Speaker 04 Honestly, sometimes I write this and then I read it over and I'm like, why did you write this? And it's too late now. Here we are.
34:16 Speaker 01 Because it's great. That's why. Keep going.
34:19 Speaker 04 Modern society is blamed for a whole host of diseases and disorders. Depression and other mental health disorders, certain kinds of cardiovascular disease, metabolic dysfunctions, even allergies and asthma to some extent. This is not a novel concept. The industrial revolution in the 19th century sparked intense discussion over how things like long working hours and stress, poor nutrition, lack of sunshine, and education for women contributed to the rise in these nervous disorders like neurosthenia or hysteria.
34:53 Speaker 01 Yeah.
34:54 Speaker 04 Setting aside the problems with some of those diagnoses, especially neurosthenia and hysteria, and whether their relationship with modernity can truly be described as causal, I think that this idea of diseases of modernity captures a reality that we sometimes struggle with. And that is that progress comes at a cost. Most of the costs that people are concerned with are general or hard to quantify. It just is like a feeling that we have. So for example, our computers are capable of more than we could have dreamed of. And at the same time, we are more sedentary and over-connected than we have been in, you know, for most of human history.
35:37 Speaker 01 Right.
35:38 Speaker 04 Contributing to chronic and mental health conditions. Have things improved overall thanks to computers? Are computers a net positive? Absolutely. Like, there's no doubt about that. But we can also consider the cost factored into that equation.
35:52 Speaker 01 Hundred percent.
35:53 Speaker 04 Yeah. And I think that we are especially prone to thinking that science and medicine moves in one direction. More knowledge, more treatments and cures, better healthcare, when it's not being thwarted by uninformed disinformation spreaders like RFK Jr. and his ilk. But unfortunately, this forward progress, it's not always the case. Or at least, there's a more nuanced story to tell. Sometimes it's more of like a two steps forward, one step back kind of a thing. And rarely are we able to predict what that backward step might look like. This was certainly the case with antibiotics. And no, I'm not talking about antibiotic resistance. I mean, people did, that is a step back, and people did see the writing on the wall almost immediately when they came out.
36:38 Speaker 04 But I mean, candida.
36:40 Speaker 01 Oh, my gosh. I love this.
36:42 Speaker 04 Yeah. When penicillin came onto the scene in the 1940s, quickly followed by other antibiotics, such as streptomycin in the 1950s, they led to a revolution in healthcare. It's a powerful story that we all know well. And if you don't, you should check out our antibiotics episodes from years back. But the miraculous recovery of patients on the verge of death from a bacterial infection, that's just one of the transformations brought about by the advent of these drugs. The other was candida. Changed from a mostly benign, which is not to say it wasn't uncomfortable or caused issues, superficial fungal infection to a sometimes invasive systemic disease.
37:23 Speaker 04 And ultimately, it led to a few fringe doctors promoting an unsupported hypothesis that to this day is used to sell people snake oil supplements that can harm much more than they can heal.
37:37 Speaker 01 Oh, I'm so shocked to hear that.
37:41 Speaker 04 I got so like just frustrated with this episode. Anyway, and that part of it. But before we can tell the story of that transformation, let's first go back in time to the early history of candidiasis.
37:56 Speaker 01 Okay.
37:57 Speaker 04 Of course, it's Hippocrates. Like, it's always Hippocrates.
38:00 Speaker 01 Honestly, I was gonna get a little sad if there wasn't because I was like, gosh, is this only gonna be a modern thing? But like, no, it must have been around forever.
38:08 Speaker 04 It's been around for, it's been around forever, forever.
38:12 Speaker 01 Yeah.
38:13 Speaker 04 Yeah.
38:13 Speaker 01 It's our friend. It lives with us.
38:15 Speaker 04 Yeah, yeah.
38:16 Speaker 01 Yeah.
38:16 Speaker 04 Sometimes it's like, you know, a little, not even codependent, but just like dependent. And we're like, we need to stop.
38:23 Speaker 01 A little much. You're like, ah, stop calling me. Stop calling me. It's too much.
38:27 Speaker 04 Do not disturb mode. Just like, yeah.
38:31 Speaker 04 Okay. Hippocrates. In one of his classic texts, he describes thrush, like oral thrush is what I'm referring to, particularly in people who are already sick or in poor health. Galen also made mention of thrush, especially in sick kids. And there's a smattering of mentions throughout the 1600s and 1700s where thrush, thrush really is what predominates throughout history. And that's understandable because, yeah.
38:56 Speaker 01 Yeah. Because it would have been there and no one was gonna talk about vaginas.
39:00 Speaker 04 Of course not. Yeah, no, no. But it was actually, thrush was recognized as relatively common in newborns and apparently so common in France that in 1786, a medical society offered a reward for its study.
39:15 Speaker 01 Oh, interesting.
39:16 Speaker 04 Yeah. Outbreaks of thrush were known to happen at lying in hospitals where people came to give birth and then spend some time in recovery afterwards. And so there would be like outbreaks throughout the hospital. And in the 1800s is when the many faces of candidiasis, or candida, began to be noted. Esophageal, vaginal, so the first vaginal yeast infection was clinically described in 1849.
39:43 Speaker 01 It's so late.
39:44 Speaker 04 And published in The Lancet. Yeah.
39:45 Speaker 01 Wow, okay.
39:47 Speaker 04 Mouth lesions, brain lesions, even intestinal disease, even some systemic infections.
39:54 Speaker 04 But disentangling what caused these infections was much more challenging, especially when this yeast can, you know, overgrow or cause infections on so many different parts on the body, in the body, everywhere. Or when there are like moral or ethical considerations, like doctors were reluctant to examine women. And even when a doctor did conduct an exam and found a yeast infection, they were like, oh, it's just a symptom of another disease. It's not a condition in its own right.
40:21 Speaker 01 Oh, that's so interesting. Okay.
40:23 Speaker 04 I mean, but similarly, oral thrush, you know, you talked about how it can almost be like brown. It was recognized or thought to be the precursor to diphtheria in a lot of cases because that that thick membrane as well.
40:34 Speaker 01 Yeah, okay.
40:36 Speaker 04 And in some cases, the infectious nature of these lesions was suspected or like couldn't really be ignored. It was like, well, it has to be infectious. And in other times, it was the infectious nature was proven by experimental infections, one of which, at least one of which, led to an infant's death.
40:57 Speaker 01 Oh, no.
40:58 Speaker 04 Healthy infant, let's just infect a bunch of these with this and see what happens. And one died.
41:02 Speaker 01 Oh, no.
41:03 Speaker 04 Isn't that absolutely horrific?
41:05 Speaker 01 That's horrible.
41:06 Speaker 04 Yeah.
41:07 Speaker 01 This was in the 1800s?
41:08 Speaker 04 1800s, yeah.
41:09 Speaker 01 Oh, God.
41:11 Speaker 04 Yep.
41:13 Speaker 04 And, you know, I think that around this time, when germ theory rose to prominence, it reinforced this idea of one microbe, one disease, one cause, one disease, kind of a thing, where one pathogen was responsible for one infection in particular.
41:33 Speaker 04 Which is great for diagnosis and developing treatments or vaccines, but at the same time, it made it harder for people to realize or recognize when something didn't fit that paradigm.
41:43 Speaker 01 Right.
41:44 Speaker 04 Such as Canada, which by this time, let's say by the early 1900s, went by a million different names. And so for the full picture of what Canada was capable of, we needed someone who was able to look past the trees to see the entire forest. And that someone turned out to be Rhoda Benham, who later became a leader in the emerging field of medical mycology.
42:08 Speaker 04 In a 1931 article in the Journal of Infectious Diseases, she put forth the idea that all of these diverse infections, from mouth to vaginal to intestinal, all of these different things, each of which had been attributed to different fungal species with like different names, because they were like, "Oh, we isolated this from the mouth. Oh, this came from the fingernail."
42:27 Speaker 01 It must be this thing.
42:28 Speaker 04 Right. It must be this different thing. It actually just came from one species, one organism.
42:34 Speaker 01 Okay.
42:35 Speaker 04 Which at the time was Monilia albacans, later turned into Candida albacans, which also, did you know, means whitening white? Like, it's like...
42:43 Speaker 01 I did not.
42:44 Speaker 04 White, white.
42:45 Speaker 01 White, white.
42:46 Speaker 04 White, white.
42:47 Speaker 01 It does tend to have white cheesiness.
42:49 Speaker 04 Yeah, exactly. She wrote, quote, "If one were ignorant of the source of these cultures, one would be unable to distinguish, for example, M. albacans isolated from thrush, from M. psilocytes isolated from sprue, and it would seem necessary for the present to regard such forms as merely strains of one species." End quote.
43:11 Speaker 01 There you go.
43:12 Speaker 04 She said, in other words, like...
43:13 Speaker 01 Just look, look at it. They're all the same, bruh.
43:15 Speaker 04 It's all the same. Stop calling these things different names. It's the same thing.
43:20 Speaker 01 The same thing.
43:21 Speaker 04 The same thing.
43:22 Speaker 01 Yeah.
43:23 Speaker 04 Which was a pretty, like, novel idea, I think, for, like, the concept that this thing could be, cause infections in such diverse, basically everywhere in the body, it seemed like. It was a new idea. And so, at this point, let's say the 1930s or so, Candida had caught the interest of a few researchers, but, to be honest, it was more of an afterthought, like, not super pressing. It was like, there were a lot of other things that people were concerned with at the time. Wasn't the hottest thing. But, the birth of the antibiotic era was about to change all that. By the 1950s, antibiotics had saved countless lives around the world, but the excitement that had accompanied the emergence
44:04 Speaker 04 of this new class of drugs was beginning to be tempered by a few unexpected consequences. New antibiotic-resistant strains causing infections that couldn't be treated, allergic reactions, toxic side effects in some of these, and a rise in Candida infections, both superficial and invasive, in those receiving antibiotics.
44:25 Speaker 04 And this last observation led the Council on Pharmacy and Chemistry of the American Medical Association to release a statement in June of 1951 that said that bottles of the three leading antibiotics should carry the following warning, quote, "Patients receiving these drugs may be more susceptible to manilial or other yeast-like organisms," end quote.
44:48 Speaker 01 Wow.
44:49 Speaker 04 Yeah.
44:50 Speaker 01 Way back when.
44:51 Speaker 04 Way back when. And it's interesting. This was not without controversy. Because first of all, it was hard, I think, for people to draw the connection between how were, how exactly were antibiotics causing this greater susceptibility? And secondly, since Canada is a commensal of humans, how do you distinguish between what is a harmless or a harmful overgrowth?
45:16 Speaker 01 Right.
45:17 Speaker 04 And thirdly, what are we supposed to do about it?
45:18 Speaker 01 Right.
45:19 Speaker 04 Right?
45:20 Speaker 01 At that time?
45:21 Speaker 04 At that time, 1951, no treatment.
45:23 Speaker 01 Okay.
45:24 Speaker 04 But within a few years, that last question, what do we do about it, would be answered 1954 with the first antifungal on the market, Nystatin, which is the market name Mycostatin.
45:34 Speaker 01 Mm-hmm.
45:35 Speaker 04 This is developed by Elizabeth Hazen and Rachel Brown a few years before. I think it was like in production and then by 1954, it was on the market.
45:43 Speaker 01 Okay.
45:44 Speaker 04 Most of the antibiotics then available were derived from fungal species like penicillin, which had used these compounds to compete with bacteria. Like, I feel like, yeah, it's, I just love, yeah. And so, using that same logic, Nystatin was developed from a bacterium, Streptomyces norci, found in soil from a friend's garden, like one of their friend's garden. And because Hazen and Brown reasoned that soil was this battleground for all sorts of microbes, they're all like, let's bring out the big guns. You know what? We're gonna, here's this compound for this and this compound for that. And I'm gonna out-compete you and I'm gonna just destroy you.
46:23 Speaker 01 You're gonna think ecologically.
46:25 Speaker 04 Uh-huh.
46:26 Speaker 01 I love it.
46:27 Speaker 04 Ecology matters.
46:28 Speaker 01 Uh-huh.
46:29 Speaker 04 And so, that's, yeah, voila.
46:33 Speaker 01 Voila.
46:34 Speaker 04 There you go. Nystatin. And then, but the other two questions, sort of like, when is Candida a problem? And what, why is it doing this? Those proved a little bit more challenging to answer. Clinical evidence was mounting that while antibiotics were associated with systemic and deadly infections with Candida through disrupting the microbiome, these weren't as common as initially thought, and it might actually have been a combination of our detection methods improving for this. And so that being partially responsible for the apparent rise, both in systemic as well as superficial. And by superficial, I mean like, on your skin surface.
47:18 Speaker 01 Mucocutaneous.
47:19 Speaker 04 Exactly. Infections. But the important lesson was that antibiotics could disrupt someone's microbiome, which provided Candida an opportunity to grow more than it ordinarily would. And that disruption could happen from other things besides antibiotics. Like, for most people, any yeast infection would be handled relatively simply through an antifungal like niestatin, and then some of the later ones that came onto the scene. But for some, such as those who are immunocompromised, that microbial dysbiosis, regardless of whether it was triggered by antibiotics or not, could result in more invasive and difficult-to-treat infections.
47:58 Speaker 04 And Candida ended up, around this time, let's say the 1970s and 80s, being labeled a, quote-unquote, "a disease of the diseased," which is like, not maybe the nicest way to put it, it's not the best way to put it, but I think what it does is it conveys that this was an infection of disruption. Something that would become even more clear in the 1970s and 80s and these decades with more patients in ICUs, you know, as healthcare and our ability to help people improved overall, we had more people who were, you know, alive in a hospital.
48:33 Speaker 01 Right, we could keep people alive even as they got sicker, and that comes with its own set of problems and complications.
48:39 Speaker 04 And then, things like organ transplant, also, you know, people who were on immunosuppressive drugs to prevent rejection, organ transplant was a very relatively, very new thing, not just relatively new. And so, and then, in, especially in the 1980s, the rise of the HIV/AIDS pandemic. And candidiasis, you touched on this a bit, but it was especially a problem for people with HIV/AIDS. And one estimate suggested that by the mid 1980s, 75% of people with AIDS had oral candidiasis. And that, of course, had the potential to become more invasive because their immune systems were so suppressed.
49:18 Speaker 01 Right.
49:19 Speaker 04 And fortunately, by that time, there were newer antifungal drugs that had come on the scene that were usually quite effective in treating these infections. And their development was in part motivated by the spread of this yeast. But the increase in awareness that Candida received during this time, it also inspired a different movement, one not entirely grounded in scientific evidence.
49:46 Speaker 01 Okay.
49:47 Speaker 04 In 1982 and 1983, two books came out claiming that Candida was the cause of a host of poorly understood and ill-defined physical and mental health issues.
50:00 Speaker 01 Okay.
50:01 Speaker 04 One book was titled "The Missing Diagnosis" by Orion Truss, and the other was "The Yeast Connection: A Medical Breakthrough" by William Crook.
50:11 Speaker 01 Okay.
50:12 Speaker 04 Literally, Dr. Crook. I can't believe it. I can't believe it.
50:16 Speaker 01 I mean, I guess you don't have control over that, but...
50:18 Speaker 04 You don't. Yeah, it just was funny to me.
50:21 Speaker 01 Yeah.
50:22 Speaker 04 And the overall premise of both of these books were that many people were unknowingly living with a chronic overgrowth of Candida, which led to an overall more immunosuppressive state and predisposed them to a variety of conditions, ranging from tissue injury and mucosal infections to mental health issues.
50:41 Speaker 01 Oh.
50:42 Speaker 04 A self-diagnosis checklist was included, along with a nine-step program, with also many sub-steps, for treating this alleged overgrowth.
50:51 Speaker 01 Okay.
50:52 Speaker 04 Diagnosis was confirmed only with a positive response from the nine-step program.
50:57 Speaker 01 What were the nine steps? Were they like, eat healthy and...
51:02 Speaker 01 Exercise, things that will make you feel better?
51:05 Speaker 04 Yes, exercise was one of them. A diet was another. Okay, here we go. I found it. Continuing observation in order that concomitant diseases can be detected, accurately diagnosed, and specifically treated. Exercise program, mental health program, avoidance of chemical pollutants.
51:24 Speaker 01 Okay.
51:25 Speaker 04 Maybe there's more information in the book on that.
51:27 Speaker 01 What does that mean?
51:27 Speaker 04 The use of antioxidants.
51:29 Speaker 01 Okay.
51:31 Speaker 04 Use of special laboratory tests, like the ratio of helper cells to suppressor cells.
51:36 Speaker 01 Okay.
51:36 Speaker 04 Blood vitamin studies, mineral studies in hair, blood, and urine, amino acid studies in urine, essential fatty acid profile. That's step six, right?
51:43 Speaker 01 Okay.
51:44 Speaker 04 Okay. Special dietary program. We'll get into that in a second. Including supplements, that was one on here.
51:51 Speaker 01 Of course, that you can only get from them.
51:53 Speaker 04 Yep. The use of antifungal agents for months, topically and orally. The use of allergenic extracts of Candida albicans for immunotherapy or provocation neutralization.
52:08 Speaker 01 Okay.
52:10 Speaker 04 That's, yeah, that is, that's nine.
52:12 Speaker 01 Okay.
52:12 Speaker 04 Yeah.
52:14 Speaker 01 Okay, Erin.
52:15 Speaker 04 So.
52:17 Speaker 01 So you do all these things at once, so you have no idea what's helping?
52:20 Speaker 04 You do all these things at once. Right, right. As far as I can tell, it's not a stepwise thing.
52:24 Speaker 01 Okay, cool.
52:26 Speaker 04 Yeah. Okay, so just to give you a better sense of like, the picture of this, I'm going to quote from Truss's Missing Diagnosis.
52:34 Speaker 01 Okay.
52:35 Speaker 04 Quote, this is just, this is just excerpted. There's a lot more where this comes from.
52:40 Speaker 01 Okay.
52:40 Speaker 04 Quote, "Depression is common, often associated with difficulty in memory, reasoning, and concentration. These symptoms are especially severe in women, who in addition have great difficulty with the explosive irritability, crying, and loss of self-confidence that are so characteristic of abnormal function of the ovarian hormones. Poor end-organ response to these sex hormones is confirmed by the common association of acne, impairment, or total loss of libido, and the whole range Of abnormalities of menstrual bleeding and cramps, as well as a very high incidence of endometriosis in those who have undergone hysterectomy. Many of these patients also start developing multiple intolerances to foods and chemicals,
53:24 Speaker 04 making it increasingly difficult for them to live in a normal environment. Many or all of these intolerances disappear as the yeast problem is brought under control. End quote.
53:34 Speaker 01 What?
53:36 Speaker 04 Yeah.
53:39 Speaker 04 Um, okay. So yeah, bringing it under control. I went through the nine steps there. It's a lot of it's the long term, not just antifungals, though. Also antibacterials were prescribed, like antibiotics.
53:53 Speaker 01 What?
53:54 Speaker 04 Yeah.
53:55 Speaker 01 Okay.
53:56 Speaker 04 Mm hmm.
53:57 Speaker 01 Okay.
53:59 Speaker 04 Candida extracts, that one for immunotherapy, and this anti, the anti-candida diet. So there's a lot to unpack here. So first, there's the vague and diverse array of symptoms of what was termed candidiasis hypersensitivity syndrome.
54:14 Speaker 01 Okay.
54:15 Speaker 04 And then women being called out in particular because of something about like sex hormones. It was unclear to me from that what the connection was.
54:22 Speaker 01 Any of that meant? Yeah. And like, why does that have anything to do with candida?
54:27 Speaker 04 Candida. Mm hmm.
54:28 Speaker 01 Okay.
54:29 Speaker 04 Birth control was also blamed.
54:31 Speaker 01 Of course. Birth control's been blamed pretty commonly.
54:33 Speaker 04 Yeah.
54:34 Speaker 01 Like realistically, you're on, even if you're on an estrogen containing birth control, you're probably having lower estrogen levels on average than you would if you were, well, certainly if you were pregnant, but also than if you were like cycling. And so there isn't really a good association between. There is a slight association between like menopausal hormone therapy and a slight increase in yeast infections, but even that is not like major.
54:54 Speaker 04 Right. And also, we're talking about yeast infections.
54:58 Speaker 01 Right. Vaginal yeast infections.
55:00 Speaker 04 Whatever this is. Yeah.
55:02 Speaker 01 Yeah.
55:03 Speaker 04 Yeah.
55:04 Speaker 01 Yeah.
55:04 Speaker 04 And I, like, the other symptoms are, like, when I said earlier that, like, these are really vague in general. It's things like headache and malaise. So things that people do experience.
55:13 Speaker 01 Right.
55:14 Speaker 04 Probably regularly in association with who knows what, many different things.
55:18 Speaker 01 I mean, it just definitely feels like this is something that's preying on people who haven't found an answer from somewhere else.
55:23 Speaker 04 Literally, that's what I have down here. Yeah. We'll get there. But I want to tell you about the diet too, because like, I think that this is still incredibly, incredibly popular. So the diet requires strict adherence and is incredibly limiting. So there's no sugar at all, even fruit, like you can't have fruit.
55:41 Speaker 01 Oh, my God. Okay.
55:42 Speaker 04 No pork, no gluten, no popcorn, coffee, nuts, mushrooms, truffles, no alcohol. Many grains are excluded, but fresh and organic meats and fish, but again, no pork, are allowed.
55:56 Speaker 01 Why no pork?
55:59 Speaker 04 Something about pork, allegedly, according to this, pork contains some sort of retroviruses that...
56:07 Speaker 01 What?
56:08 Speaker 04 Yeah.
56:10 Speaker 04 Yeah. Like that retroviral something.
56:13 Speaker 01 I'm not like pro, I mean, I love bacon, but I know it's terrible for me, but like, it's not causing candida.
56:20 Speaker 04 It's not. It's not. And these books, though, and the idea that they promoted became wildly popular, like selling out book prints or whatever, and leading many people to seek months of systemic and topical antifungals from their doctor. They discontinued birth control and they started to take a suite of supplements that were probably not great. Actually, there have been a few cases of people who either go on the diet or start taking these supplements that end up putting them in a hospital.
56:53 Speaker 01 Oh, geez.
56:53 Speaker 04 Or they're on these antifungals for so long, anyway. So this, it got to a point, it got to be such a problem that by 1986, or in 1986, the Executive Committee of the American Academy of Allergy and Immunology released a statement listing their critique of the candidiasis hypersensitivity syndrome. And I'll link to this because it has like, almost like a point by point refutation. And their ultimate conclusion was that, quote, "On the basis of the evidence so far reviewed and until appropriate published evidence to the contrary is brought to its attention, the Practice Standards Committee recommends that the concept of the candidiasis hypersensitivity syndrome is unproven," end quote.
57:33 Speaker 01 I mean, pretty straightforward.
57:35 Speaker 04 It didn't really do anything. Over the next decade, though, researchers like started to look into this with carefully designed clinical trials because they're like, if this is the thing, this is, we have a path forward, right?
57:47 Speaker 01 Right. This is real. Let's figure it out.
57:50 Speaker 04 Let's figure it out.
57:51 Speaker 01 So we can treat it well.
57:52 Speaker 04 They tested the anti, the anti Candida diet. They, there was a test or a trial with prolonged treatment with niestatin and also looking, screening for Candida throughout the body. No strong evidence emerged for the condition. And if you look at candidiasis hypersensitivity syndrome on Google Scholar, you will find a few papers from the 80s and early 90s, but anything that's more recent tends to come from things like the Candida clinic or like the Candida, whatever sort of Candida pro.
58:25 Speaker 01 Right.
58:26 Speaker 04 Pro this idea.
58:27 Speaker 01 They're clearly like, they have an angle.
58:28 Speaker 04 Not peer reviewed.
58:29 Speaker 01 Because they're trying to sell you a supplement.
58:31 Speaker 04 Supplement or something, yeah, a book, yeah. But, and, and in fact, because like one of the ideas that they promote is that, okay, you need to like, and why the diet is there is that it cuts down Candida in your gut. And there's actually a paper from 2022 that suggests that Candida in your gut is a mutualistic beneficial bacteria, beneficial organism.
58:56 Speaker 01 Right.
58:57 Speaker 04 And it's a sign of a, can be a sign of a healthy gut.
59:00 Speaker 01 A healthy gut. I mean, you want your gut microbiome to be quite varied.
59:03 Speaker 04 Yes, you do. You do. But yeah, nevertheless, this persisted. This idea of Candida overgrowth or candidiasis hypersensitivity syndrome, and you've got countless organizations, supplement companies, and forums dedicated to spreading the word. And why it has remained so popular, I think, comes down to two main things. And the first is that, is what you touched on. Medicine doesn't have all the answers and people seeking help are sometimes dismissed or have their questions ignored and their concerns ignored. And I don't doubt that people who think they have this condition or are experiencing symptoms of candidiasis overgrowth or Candida overgrowth are probably experiencing uncomfortable,
59:48 Speaker 04 disruptive, or even debilitating symptoms. But so far, no evidence points towards Candida as the culprit.
59:56 Speaker 01 Mm hmm.
59:57 Speaker 04 Doesn't mean that someone isn't having headaches or digestive issues, but that it's probably not Candida.
1:00:02 Speaker 01 Right.
1:00:03 Speaker 04 And the Canada diet probably helps because you're paying attention to what you're eating. You're you're cutting out a lot of things that probably don't make you feel great.
1:00:12 Speaker 01 Right.
1:00:12 Speaker 04 Right?
1:00:13 Speaker 01 It would be great if we could all cut out sugar.
1:00:15 Speaker 04 Yes, probably. I mean, yeah, there are some.
1:00:18 Speaker 01 It would be great if we focused.
1:00:20 Speaker 04 Yeah, at least tone it down a bit, or like some elements, but like not, yeah.
1:00:24 Speaker 01 Although not fruit. Fruits are great.
1:00:25 Speaker 04 Yeah, yeah.
1:00:26 Speaker 01 Please.
1:00:28 Speaker 04 I eat so much, so many blueberries.
1:00:30 Speaker 01 I know that about you.
1:00:31 Speaker 04 Yeah, it's one of my absolute favorites. I mean, it's why I love Costco, just.
1:00:36 Speaker 01 Just for the blueberries.
1:00:37 Speaker 04 Everything else. Clam shells. Yeah, fistfuls of blueberries.
1:00:41 Speaker 04 But but again, these, just because you're receiving a benefit or feel better from the Canada diet, doesn't mean that your Canada levels are changing. In fact, there have been studies that indicate that there is no change.
1:00:56 Speaker 04 And honestly, it would be great if it if it were Canada. Wouldn't that be nice? Because there'd be, here's, here's the straightforward answer. There's probably a straightforward fix.
1:01:04 Speaker 01 Right.
1:01:05 Speaker 04 This is what we can do. People who are desperate for answers, desperate for relief, may find themselves looking outside of medicine for someone to tell them what's happening. Which brings me to the second reason why I think this has remained so so popular. It's because there are countless people who are happy more than willing to profit off of it.
1:01:25 Speaker 01 I know.
1:01:26 Speaker 04 There was once, I just, I Googled anti-Candida supplements just to see what was out there, and it's like endless options, of course. And I just, I'm, I'm so livid. Like, livid isn't even the right word. I'm just so exhausted by the fact that this is a thing that is continuing to grow and grow and grow. There was one supplement business, and I won't name the name of it, but it popped up as one of the the the companies that's selling these anti-Candida supplements. And I looked up, okay, what is their net worth? What is their income? What do they get every year? Tens of millions of dollars every year for "medicine-backed," quote unquote, absolutely not medicine-backed, cleanses that promise to restore gut health
1:02:11 Speaker 04 or make you free from Canada.
1:02:14 Speaker 01 Erin, I mean, it all just makes me want to do a whole nother supplements episode because there's still so much more there.
1:02:19 Speaker 04 It's, it's even like when we did that, what, last year?
1:02:23 Speaker 01 Yeah, was that last year already?
1:02:24 Speaker 04 It's it's worse.
1:02:25 Speaker 01 I know.
1:02:26 Speaker 04 It's worse. It's growing and growing and growing.
1:02:28 Speaker 01 There also, I've been been looking at this a lot. There are so many, because you said these, a lot of these people who promoted this idea back in the 80s were physicians.
1:02:36 Speaker 04 Oh, so was the person who has the supplement.
1:02:38 Speaker 01 Right. That is what is on the social medias right now, which I won't call out my name. But like, almost every very prominent, even physician influencer or whatever, sells at least one supplement or has advertised for at least one supplement or whatever. And it just makes it like, ah, it makes it so, so, so hard because you just can't. And it's not like we said in our supplements episode, it's not like supplements are evil. It's not like they're all bad. It's just that they're completely unregulated. And so many of them are profiting off of misinformation.
1:03:11 Speaker 04 I mean, yeah, in in terms of the morality question, I I feel like it is pretty immoral to manipulate people and
1:03:20 Speaker 01 Oh, totally.
1:03:20 Speaker 04 put fear into them to sell, to make money, to make yourself richer.
1:03:23 Speaker 01 A hundred percent. But I just meant like, we do use supplements in medicine for things.
1:03:28 Speaker 04 Yes, and we're painting with a broad brush here. But I think that like, when we're talking about someone who's taking a supplement to reduce their candida levels.
1:03:36 Speaker 01 Right.
1:03:37 Speaker 04 Absolutely garbage.
1:03:39 Speaker 01 There's no evidence. There's no evidence. Yeah.
1:03:41 Speaker 04 It's all, it's all, yeah, it's predatory, predatory garbage. So, um, yes. And then I think the other issue with this, sorry, I didn't really mean to get this like upset about things.
1:03:54 Speaker 01 I got you into it, so keep coming.
1:03:57 Speaker 04 But there's, you know, I was also looking up, I was just curious because especially yeast infections, I have heard so many different home remedies and you've got people who are like, put a clove of raw garlic, cut in half, tie it around a string, just coat it in yogurt, coat, just like shove a bunch of yogurt up your vagina. That'll get rid of it. A jade egg or whatever, you know, like I'm sure that there's something on that website that we. Yep.
1:04:25 Speaker 01 Yeah.
1:04:26 Speaker 04 Disapprove of. But all of these things, like, they're misguided. And it is, oh, it just, it reveals so much of what is wrong with expertise, medicine, people being missed by medicine.
1:04:41 Speaker 01 Yeah.
1:04:42 Speaker 04 And like, our limited capacity to answer all these questions.
1:04:45 Speaker 01 Right.
1:04:45 Speaker 04 Probiotics, do they work? Maybe.
1:04:47 Speaker 01 Maybe.
1:04:48 Speaker 04 Maybe not.
1:04:48 Speaker 01 Maybe not.
1:04:49 Speaker 04 That question, we cannot answer right now. What is even in a probiotic, right? Which bacteria matter, in what quantities, which don't matter? Each person is unique, their microbiome is unique. I mean, we don't even have, like, you know, I was thinking about this in like, an actual puzzle, and you know, you always put the edge pieces together first? Like, we're still flipping over pieces. Like, we're not even close to having that.
1:05:11 Speaker 01 That's so true. That's so true. We don't even know how many puzzle pieces we're dealing with.
1:05:13 Speaker 04 Absolutely not. Could it be a 1,000-piece puzzle?
1:05:16 Speaker 01 5,000?
1:05:17 Speaker 04 Or like, a 100,000?
1:05:18 Speaker 01 Right.
1:05:20 Speaker 01 That's so true.
1:05:21 Speaker 04 And I think that, yeah, I think that the, the fact that the anti, the anti-Canada diet and these alternative approaches to treating yeast infections, just as an example, the, as, are as prominent as they are, I think speaks to the failure of medicine to adequately meet people's needs, the disgusting greed and lack of regulation that allows people to sell snake oil on the basis of fear and lies. And also, I think it shows the very human tendency to want answers, to want to take action. And Erin, I, I'm sure that, you know, things have improved, or maybe there's reason to hope, good news on the horizon? Sorry to end this so depressingly.
1:06:04 Speaker 01 Oh, that's okay. I don't know that what I'm gonna say is gonna be any less depressing, but we can get into what the landscape of Canada is like today.
1:06:12 Speaker 04 Let's do it.
1:06:13 Speaker 01 Okay.
1:06:45 Speaker 01 So when it comes to, I'll start with invasive candidiasis.
1:06:49 Speaker 04 Okay.
1:06:49 Speaker 01 Because that's obviously the most severe forms of candidiasis. We're talking systemic infections. A Nature Reviews Disease Primers from 2024 reported an estimated community-wide incidence rate. So if you're just looking at general population, you might think it's not that bad. It's around four cases per 100,000 people in high-income countries. Ah, not that bad. But you would be wrong if you thought of it that way. Because this is not a disorder, systemic invasive candidiasis, that is particularly prevalent amongst the general population.
1:07:28 Speaker 04 Right.
1:07:28 Speaker 01 But in hospitalized patients worldwide, we see about 100 cases per 100,000 hospital admissions. And in the ICU, an estimated five to seven cases per 1,000 ICU admissions. In newborn babies, especially premature newborn babies, we see 12 cases of invasive candidiasis per 100,000 births of premature babies in the US.
1:07:55 Speaker 04 Wow.
1:07:55 Speaker 01 So this is a disorder, a disease, that for most people who are listening or walking around, like on your commute to work, if you're hearing this, you might think it's not that common. But if you work in a hospital, if you're unlucky enough to end up sick in ICU, this is a very serious and seriously common problem. And with the rise of other strains of Candida, like Candida oris, which was first found only in 2009. It's a very, very new, newly identified pathogen.
1:08:30 Speaker 04 Yeah.
1:08:31 Speaker 01 This is a species that was first identified in Japan. And since 2009, has been found in more than 30 countries. It spreads really rapidly through hospital settings, and it really rapidly gains resistance. A lot of times, the different strains of C. oris have resistance to begin with, but then it picks up new resistance. So we see pan resistance. We see resistance in C. oris, some strains, to almost all of the antifungals that we use.
1:09:01 Speaker 01 And it's been in the US since at least 2013. And according to the CDC in 2023, there were 4,514 new clinical cases of C. aureus in the US in 2023. And it's been increasing, like when you look at the graphs on the CDC C. aureus page, it is like whoop, whoop, it's exponential growth right now.
1:09:20 Speaker 04 Yeah, it is. Yeah. Well, because it gains a foothold, I feel like in hospital settings so easily too, where it's just like you can't get rid of it.
1:09:29 Speaker 01 Right, right. Yeah. And that's not the only species that is of increasing concern. Candida parasillosis is a whole species complex that is also found really commonly. It's not like a new infection per se, but we're seeing increases in flucanazole resistance, which is one of the main antifungals that we use, especially for like mucocutaneous infections and things like that. We also are seeing increasing rates of what is now called Naucysium mycis globrotis, which used to be Candida globrata.
1:10:03 Speaker 04 That just went, rolled right off your tongue. I'm so impressed.
1:10:07 Speaker 01 I practiced so much.
1:10:10 Speaker 01 Like every time I wrote it, I practiced saying it out loud. But this, we also are seeing both increasing in distribution. It's like the second most important species in the United States and in Northwestern Europe. But infection tends to be more severe and it rapidly requires resistance compared to Candida albicans, which tends to, it's not like that you can't have resistance, but it's just for whatever reason, not as good at acquiring resistance genes.
1:10:37 Speaker 01 So there's a lot of different species that are kind of of concern and that are on the rise. When it comes to vulvovaginal candidiasis, which we talked about already affects 75% of people with vagina at least once, literally so many of us. But even recurrent vulvovaginal candidiasis affects an estimated 138 million people with a vagina every year worldwide, and it's on the rise and estimated to hit close to 160 million by 2030.
1:11:11 Speaker 04 Okay, a couple of questions. You said this is four to five times a year?
1:11:15 Speaker 01 At least four recurrent infections a year. Some papers call it at least three recurrent infections a year, but most, most of them are four.
1:11:23 Speaker 04 Um, okay. A quick question before we talk more about vaginal yeast infections. The other species that you mentioned of Candida, do they tend to colonize the same or like cause infections? Because albicans is a commensal, but these don't seem to be commensals. They seem to be pathogenic, or are they?
1:11:43 Speaker 01 Yeah. So with Candida auris, it's so new that I don't know that we know.
1:11:50 Speaker 04 Okay.
1:11:50 Speaker 01 It like, you know, it wasn't ever found before. So has it been, you know, certainly it can colonize our skin. I think it's estimated that like 10% of people, if you just like screen people coming into a hospital or something, that 10% of people who are colonized will go on to develop an invasive infection. So it's not like it causes infection in all of them. And same thing with, you know, what is now Nacisae mycis globraeus and Paracilosis. Why is that one harder than?
1:12:17 Speaker 04 Yeah, the other ones you're like.
1:12:19 Speaker 01 Right. And there's also, there's more too, right? Like there's other candidal or what used to be Candida and are now, you know, reclassified. So most of these can be found on some percentage of the human population, just as commensals.
1:12:34 Speaker 04 But in terms of the infections that they will cause, it's the same sort of suite of infections?
1:12:40 Speaker 01 In theory, in theory, yes, they could. But because I think because especially with C. auris, we are screening for it in, we are seeing it more as an invasive infection.
1:12:53 Speaker 04 Okay.
1:12:54 Speaker 01 Where because, and what does this just come down to? The fact that Candida albicans is still the most prevalent. So if there's going to be an overgrowth, it's going to win out in most cases. I don't know.
1:13:06 Speaker 04 Okay.
1:13:06 Speaker 01 Certainly what, uh, what used to be Candida globraeus and is now Nacisae mycis globraeus, it, it causes quite a lot of vaginal yeast infections. Um, and we see, you know, Paracilis. As well. So we see all of these, but still overwhelmingly albicans is the most prevalent.
1:13:23 Speaker 04 So if recurrent yeast infections are on the rise, vaginal yeast infections are on the rise, are they caused by albicans? Or is it one of these other species? Like how much, when you have a yeast infection, it's not like they will necessarily culture, or do they always?
1:13:39 Speaker 01 Not necessarily. That's the problem. You don't necessarily have to culture to get the data on what species it is. Like where I work, we do PCRs and we, we can then strain type it and species type it.
1:13:51 Speaker 04 But you always do strain type and species type, or that's what does happen?
1:13:55 Speaker 01 Yeah. The PCR that, at least where I work, and this is not everywhere, but where I work, I swab everyone if I'm worried.
1:14:02 Speaker 04 Yeah.
1:14:03 Speaker 01 Try not to treat empirically. Lots of people will just get empiric treatment. And the PCR test that we do checks for multiple different strains. So it's able to, and multiple different species. So it's able to tell us what that species is, which also will give us a hint as to whether it's more likely to be resistant. For example, if you're talking about an invasive infection in a hospital setting, yes, you're going to be culturing that, or you're going to be doing something to figure out exactly what species we're talking about. But for a lot of mucocutaneous infections, people might be treated just empirically, meaning just based on clinical exam, which I'll be honest, it's usually pretty obvious, but not always. And the reason I always swab is because a lot of times you've got BV and yeast overgrowth. Like it's not only just a one thing.
1:14:46 Speaker 01 But a lot of people will be treated empirically, either because they don't have access to something like PCR, or they can't afford it because it might be, you know, cost prohibitive. Or a lot like what we would do where I worked during residency is put it under a microscope and look at it under the swab. You know, look at it, look at the swab under the microscope and then you can see the hyphal growth, but I don't know what species that is. And so then you're at least knowing for sure that it's a yeast infection and not a yeast plus other things.
1:15:12 Speaker 04 Right, right.
1:15:13 Speaker 01 But then you don't necessarily know what species it is. So it totally just depends where you are and what the healthcare infrastructure is like.
1:15:18 Speaker 04 Okay.
1:15:19 Speaker 01 And so we don't know, to answer your question of, is it just, it's probably mostly still the albicans on the rise, but it's contributed by all of these other species as well. By the increasing antifungal resistance that we see.
1:15:32 Speaker 04 Mm hmm.
1:15:34 Speaker 01 Um, especially in these other species of Canada, which again are on the rises in a lot of cases. And so that is a very real and very uh scary um aspect of Canada right now is just the rise in antifungal resistance, especially when it comes to C. aureus, something like 13 to 35% of isolates are found to be resistant to essentially all the antifungals that we have.
1:16:05 Speaker 04 And we just detected this 16 years ago?
1:16:08 Speaker 01 Correct.
1:16:10 Speaker 04 That is very scary.
1:16:13 Speaker 01 I know. Um, there's a lot of need, obviously, for research in better, more accurate and faster diagnostic tools and better treatment options. There are some that are like being fast-tracked and, you know, we're trying. There is actually a new drug approved for, I believe it's approved for recurrent vulvovaginal candidiasis.
1:16:34 Speaker 04 Okay.
1:16:35 Speaker 01 Um, that just got approved a couple of years ago. I guess it reduces adverse reactions compared to fluconazole, um, but it doesn't necessarily help with azole resistance. Another thing that's commonly used for vulvovaginal infections is boric acid, uh, boric acid, like vaginal suppositories. Um, it's quite effective. It's like a broad spectrum antimicrobial and it generally is pretty safe and well tolerated, but it's not like approved for use by the FDA. It's also not commonly used in Canada or the EU, so it's actually really hard to get access to. Like you have to go through a compounding pharmacy or you have to make your own suppositories. I don't really understand why. Like, I guess nobody, no pharmaceutical company has bothered to try and make a profit off of it. Is that the answer? I don't know.
1:17:20 Speaker 04 Uh, yeah, maybe it's like in public domain or whatever, like.
1:17:23 Speaker 01 Right. But are you mean like, why can't you just get a suppository? I don't know.
1:17:26 Speaker 04 I feel like I remember, and I'm probably going to like completely butcher this recollection because my memory is not good. But in, so that last season, I did a book club episode on vagina obscura with Rachel Gross. She's amazing. And in her book, she talks about using a vaginal microbiome transplant, kind of like fecal transplants.
1:17:49 Speaker 01 Yeah.
1:17:50 Speaker 04 For, but I don't know if it was to treat recurrent yeast infections or like a really persistent BV. But anyway, I loved that idea.
1:17:59 Speaker 01 I love all of the ideas that are looking more at our microbiome and our microbial communities and how they interact, because we know that that's such a big driver of these kinds of overgrowth infections, opportunistic infections. So I don't know a lot about that, but it's really interesting to look into.
1:18:18 Speaker 04 And I feel like we were, I was a little bit like down on probiotics or like that's maybe the impression that I gave. And I'm, I'm not like, I think there's a lot of potential. I just don't think we're at the stage where we can say, this will do this.
1:18:30 Speaker 01 No, and we're definitely not at the stage of saying, put yogurt in your vagina. This is not a medical advice podcast.
1:18:35 Speaker 04 No.
1:18:37 Speaker 01 There is though, also, people are working on a vaccine for recurrent vaginal candidiasis, specifically. It's an interesting type of vaccine because it is based on like a candida protein of some kind. But the idea, at least who they're targeting right now, like who, who they're testing it on is people who've had recurrent infections. So it's kind of like to reduce the risk of recurrence, rather than just like something to give to the whole population or something like that.
1:19:06 Speaker 04 I see.
1:19:07 Speaker 01 But yeah, it's really promising. I think the last paper that I saw on it, which might have been a year or two old now, they were in stage two trials. So I don't know if they've moved further from that. And then there's also a new type of antifungal that was recently approved. And the reason, for invasive infections, and the reason that's exciting is because it's easier to administer. You don't have to do it daily. You can do it once weekly. And you can kind of front load it, which means, because the other thing, and I didn't even get into this because there's so many components you could talk about. When it comes to invasive candidiasis, these systemic infections, the long-term sequelae of them can be really severe. And there's not enough research into the quality of life effects that we see after
1:19:51 Speaker 01 a systemic infection. But they're really substantial. You know, if it gets into the eye, it can cause permanent blindness. People tend to be really sick before they even get Get a fungal infection. And so then the recovery from that, like from a prolonged hospitalization or ICU stay is really substantial. So the fact that people are working on trying to make treatment so that it could potentially be done more in the outpatient setting is really, really huge and important. So there's a lot more that you can read about when we tell you about our sources.
1:20:24 Speaker 04 Sources time? Okay, okay, let's see. I have several, a bunch, but I'm going to shout out two in particular. So one is a book titled Fungal Disease in Britain and the United States, 1850 to 2000 by Aya Homi and Michael Warboys. And then there was, oh, if you're interested in reading like a paper about this niestatin relationship and like the hypersensitivity candidiasis hypersensitivity syndrome, there was a paper from 1990 published and I feel like it was the New England Journal of Medicine that studied the administration of niestatin and whether it relieved any symptoms and like anything like that. And
1:21:04 Speaker 04 it's called, it's by Dismuks, a randomized double-blind trial of niestatin therapy.
1:21:11 Speaker 01 Love it. I had a number of papers for this. One of my favorites, just for like overview of Canada was a Nature Reviews Disease Primers from 2024 called Invasive Candidiasis. I also loved a couple of papers I had about the like virulence, but my favorite, I think, was from the journal Virulence, who knew, in 2022 titled Pathogenesis and Virulence of Canada Out the Cans. And then I have several on the introduction and emergence of some of these other species of Canada and what used to be Canada. And then the paper that was really great on recurrent vulvovaginal candidiasis was called Global Burden of Recurrent Vulvovaginal
1:21:53 Speaker 01 Candidiasis: A Systemic Review in the Lancet Infectious Diseases from 2018. But I've got more and you can find all of them on our website, thispodcastmucaly.com, under the
1:22:02 Speaker 04 You certainly can. A big thank you again to the provider of our firsthand account. It really means so much to, for us and other people to hear your story. We appreciate it.
1:22:13 Speaker 01 Yeah, thank you. Thank you.
1:22:15 Speaker 04 Thank you also to Blood Mobile for providing the music for this episode and all of our episodes.
1:22:21 Speaker 01 And thank you to Leanna and Tom and Brent and Pete and Jessica and everyone else at Exactly Right Network for helping make this podcast and the video. Did you know we're on YouTube? Possibly.
1:22:33 Speaker 04 And a big thank you to our listeners, our patrons. Your support means the world to us. Like, we, we do this for you and it means so much that you actually tune in and
1:22:45 Speaker 01 Yeah.
1:22:45 Speaker 04 hear what we have to say.
1:22:47 Speaker 01 Thank you so much.
1:22:48 Speaker 04 Thank you. Well, until next time, wash your hands.
1:22:52 Speaker 01 You filthy animals.
1:23:21 Speaker 01 What is one thing many of us deal with every single day but rarely talk about? Dry hands. Whether you frequently wash your hands or deal with harsh weather, your hands can be left feeling dry, rough, cracked, and even uncomfortable. That's where O'Keefe's Working Hands Hand Cream comes in to help. The fast-absorbing formula goes on smoothly and it won't leave behind a greasy residue, so you can get back to your busy day without ever missing a beat. And because a little will go a long way, O'Keefe's Working Hands Hand Cream is effective, dependable, and economical, too. Whether you're dealing with harsh weather outside, demanding work, or everyday wear and tear, O'Keefe's Working Hands works just as hard as you do. So keep your hands hydrated, smooth, and feeling comfortable all season long.
1:24:06 Speaker 01 Visit okeefescompany.com today. That's O-K-E-E-F-F-E-S company.com for guaranteed relief. O'Keefe's Working Hands. Yeah, it works.
1:24:18 Speaker 05 With ChatGPT, you can do more than get answers. You can get things done. Whether you're leading a big project, planning an elaborate trip, or trying to balance work and life, ChatGPT can help. Give it a goal, plus things like files, notes, or project plans, develop a trip itinerary with daily updates, or create a prioritized schedule, so you can spend less energy sorting out the details and more on bringing your biggest ideas to life. Get started at ChatGPT.com.
Previous Special Episode: Mary Roach & Replaceable You Next Ep 189 Newborn screening: The future is here Page updated November 1, 2026 · transcript and summary are machine-generated
