Candida albicans is responsible for an incredible amount of misery
1 CommentFriday, 2 September 2016 | Editor
SIGN UP for free newsletters and make sure you are kept up to date with new health articles (and get 20% of your first order for health supplements).
View or buy: Anti-fungal supplements
Candida albicans is responsible for an incredible amount of misery.
The enormity of the problem has become apparent in recent years with the advent of successful treatment. If a random sample of patients complaining of miscellaneous symptoms is given anti-candidal therapy many of them will exhibit a marked diminution in symptoms over the next few months and some will exhibit a dramatic return to good health.
This article discusses the varied nature of the clinical manifestations of candidiasis and describes a comprehensive approach to its treatment.
Causes of candidiasis – Diagnosis - Symptoms
Therapists we are now in a position to help many of those with chronic illness to an extent previously unimaginable.
Candida is in the intestine. Harm occurs only when the normal ecology of the bowel is disrupted so that Candida can proliferate and push significant amounts of waste into the general circulation, which can then impair the functioning of any organ. About 100 such waste and secretory products are collectively known as Candida toxins. This can change into an invasive fungal form which can penetrate the intestinal wall and spread to other organs. When "on site" at other organs, not only will there be tissue damage and inflammation but the level of Candida toxins locally will presumably be higher than when derived from an intestinal infection.
Causes of candidiasis
Poor immunity is undoubtedly a major factor in allowing Candida to overgrow. A weak immune system appears to be the norm these days, the main reason for which is probably nutrient deficiency. Almost every nutrient known has a role to play in creating immunity, and since most individuals exhibit multiple nutrient deficiencies, they inevitably have chronically impaired immune systems.
Heavy metal toxicity, particularly lead (from petrol and lead plumbing) and mercury (from amalgam fillings) is immunosuppressant, as is chemical overload from our highly polluted and unnatural environment.
Psychological stress appears to be a much overlooked cause of immune weakness, and the same is true of electromagnetic and geopathic stress.
Since the presence of Candida burdens the immune system and its toxins are immunosuppressant, a vicious cycle exists. Food and inhalant allergies, which Candida commonly causes, similarly burden the immune system, fuelling the vicious cycle. Additionally, nutrient deficiencies induced by Candida may impair immunity, and thus also contribute to the vicious cycle.
Here are some important points:
- Excess sugar consumption suppresses immunity and alcohol has a similar effect. (Sugar, of course, also feeds Candida.)
- Caffeine is an adrenal stressor, and help to allow development of candidiasis.
- A deficiency of dietary fibre encourages intestinal candidiasis because dietary fibre gives rise to short-chain fatty acids, which inhibit the growth of Candida.
Clinical overusage of antibiotics is widely recognized to precipitate Candida overgrowth. Antibiotics kill the indigenous mucosal bacteria that normally compete with Candida for food and space, and also secrete anti-candidal substances. In view of the explosive intensity of the overgrowth that can follow antibiotic usage, other pro-candidal mechanisms undoubtedly exist. These could include a direct immunosuppressant effect of antibiotics; the release of immunosuppressant toxins from killed bacteria; and a direct stimulant effect on yeast growth. Whether the intake of antibiotics in trace amounts from eating livestock treated with antibiotics is sufficient to exert a pro-candidal effect is an unresolved question.
Finally, the popularity of oral contraceptives and hormone replacement therapy has played its role. Candida is believed to possess both oestrogen(8) and progesterone(3) receptors, and exogenous sex hormones therefore feed the yeast desired molecules. Other steroids used medically such as corticosteroids appear to exert a similar effect,(3) and additionally are immunosuppressive.
The presence of Candida overgrowth can be detected in a number of ways. These include:
- the taking of a clinical history
- determination of blood alcohol after a carbohydrate load;
- dark-field microscopy of blood;
- urine testing;
- Vega testing;
- and Vega Biokinesiology.
Since candidiasis is omnipresent in varying degrees, a further approach is to assume that it is present until proved otherwise by a three-month trial of anti-candidal therapy.
Symptoms of candidiasis
Virtually everyone exhibits minor symptoms of candidiasis, while about one third of the population (at least in the West) is severely affected and experience over many years supports this remarkable assertion. Candidiasis is a precursor for any and every degenerative disease [since it causes] injury to every single body system so the importance of acknowledging the prevalence of Candida is at once apparent.
Candida overgrowth causes many symptoms, the most common of which in our experience are
- bloating (gas),
- food allergies,
- carbohydrate craving,
- impaired memory,
- poor concentration,
- a "foggy" brain with feelings of unreality,
- general malaise.
Additionally, numerous other symptoms may less commonly be exhibited. Most frequently these include:
- menstrual irregularities,
- loss of libido,
- stiff and painful joints,
- muscle pain,
- inhalant allergies,
- chemical sensitivities,
- catarrh, hay fever,
- persistent cough,
- cardiac arrhythmia,
- discoloured nails,
- acne and other skin eruptions,
Candida may also contribute significantly to the causation of a number of medical conditions as diverse as premenstrual tension, irritable bowel syndrome, asthma, eczema, psoriasis, urticaria, epilepsy, schizophrenia, multiple sclerosis, hypoadrenia, hypothyroidism, hypoglycaemia, ileocaecal valve dysfunction, and childhood hyperactivity. The role of Candida in some of these conditions is discussed below.
A correlation between healthy adrenal glands and the absence of candidiasis suggests that healthy adrenal glands help protect against candidiasis. We now realize that the other side of the coin is perhaps more important: Candida commonly impairs adrenal functioning, sometimes severely so.
In one lady in whom candidiasis was a major cause of hypoadrenia, it was noted that the amino acids that supported her adrenal glands best were taurine, cysteine, and glycine - all antioxidants. Following up this clue it was ascertained that Candida and its toxins appeared to be exerting a direct cytotoxic effect on the adrenal glands via free-radical activity.
Another problem is Candida-induced autoimmune damage to the adrenal glands. Several studies implicate Candida as a major cause of autoimmunity. Further, it is possible that antibodies directed at Candida may cross-react with human cells. It is therefore possible that the presence of Candida in tissue causes the body to regard that tissue as non-self and therefore to initiate autoimmune attack.
Additionally, Candida toxins interfere with acetyl coenzyme A activity, which could inhibit the synthesis of adrenal steroids, and further, it is believed that Candida possesses receptor sites that can bind adrenal steroids thus competing with host cells, producing apparent adrenal insufficiency.
The functioning of the thyroid gland is one of the first activities interfered with by Candida, and it has been observed that 90% of Candida victims have low thyroid function. As with adrenal hormones, it appears that Candida receptor sites can bind thyroxine and render it physiologically unavailable. This may help explain the common finding of a normal blood level of thyroxine in a person who is clinically very obviously hypothyroid. Moreover, candidiasis is commonly associated with zinc deficiency, and since zinc is necessary for the conversion of thyroxine to its active form, tri-iodothyronine, such a deficiency could produce symptoms of hypothyroidism (which also could occur in the presence of normal blood levels of thyroxine).
Again, as with the adrenal glands, damage to the thyroid gland from Candida-induced free-radical activity and Candida-induced autoimmunity is a possibility.
The relationship between food allergies and candidiasis is well-known. Candida damages the gastrointestinal mucosa which leads to an increase in the permeability of the mucosa ("leaky gut" syndrome). This allows large molecules of incompletely digested food protein to enter the bloodstream, thus provoking an immune response. Additionally, irritation and inflammation of the intestine caused by Candida may impair local immunological defence mechanisms, which could result in food allergies, as could the more general immune dysfunctioning that is normally associated with candidiasis.
The liver takes the full brunt of Candida toxins emanating from the bowel (at least one of which - acetaldehyde - is a known hepatotoxin) and also, Candida itself is likely to disseminate to the liver readily. Liver function might therefore be expected to be disturbed in candidiasis, and this could encourage the development of food allergies since the liver is responsible for removing foreign proteins from the circulation. Candida-induced hypoadrenia might also be part of the picture. (Adrenal hormones modulate allergic responses.)
The other side of the coin is that food allergies distract the immune system,(6,7) and further, produce immunosuppressive chemicals such as histamine and prostaglandin E2,(4) and therefore could predispose to candidiasis.
The relationship between Candida and hypoglycaemia is complex. Both conditions can independently give rise to similar symptoms (fatigue, headaches, anxiety/depression, forgetfulness, poor concentration, carbohydrate craving); hypoglycaemia, by impairing immunity can contribute to the development of candidiasis; and candidiasis is implicated as a cause of hypoglycaemia.
In candidiasis, magnesium, vitamin B6, zinc, and fatty acid deficiencies are all likely to occur and could predispose to the development of hypoglycaemia. Hypothyroidism, hypoadrenia, and liver dysfunction induced by Candida could also give rise to hypoglycaemia. Further, there is no doubt that hypoglycaemia can result from food allergies, which, as noted above, are common in candidiasis.
Additionally, sugar metabolism at the cellular level may be impaired by Candida (Candida toxins interfere with acetyl coenzyme A activity, thus reducing citric acid production), and this could give rise to hypoglycaemic-like symptoms.
Most women with premenstrual tension are suffering from systemic candidiasis,and a cause-and-effect relationship may sometimes be the case, since treatment of the candidiasis can eliminate the premenstrual symptoms. Candida infection disrupts the metabolism of vitamin B6 and essential fatty acids, and is associated with low levels of magnesium, all of which could be relevant to premenstrual tension. Further, Candida can apparently secrete oestrogens, which could contribute to the oestrogen overload that characterizes most women with premenstrual tension. It is also possible that Candida-induced liver dysfunction impairs the liver's ability to degrade oestrogen. However, tissue responsiveness to oestrogen is reported to be impaired in candidiasis, presumably because the yeast's oestrogen receptor sites bind oestrogen of human origin, rendering it physiologically unavailable. The overall effect on oestrogen balance may therefore be variable, depending on which of these factors predominate.
It can therefore be postulated that the hyperactivity results from the effect of Candida toxins on brain function, the ingress of food allergens and exorphins through a gut rendered leaky by Candida, Candida-induced chemical sensitivities, and Candida-induced nutritional deficiencies (magnesium, zinc, pyridoxal phosphate, and gamma-linolenic acid). Magnesium and zinc deficiencies could predispose to the heavy metal toxicity (lead, copper, and aluminium) implicated by some authors. Dyslectic tendencies appear to be related to Candida-derived acetaldehyde interfering with corpus callosum function.
Ileocaecal valve dysfunction
The ileocaecal valve (ICV) comprises a sphincter-like thickening of the circular muscle at the distal end of the ileum and a pair of transverse folds or lips that project into the lumen of the caecum. The purpose of the valve is to prevent the contents of the ileum (chyme) from passing into the caecum before nutrient and water absorption is complete, and to prevent the reflux of colonic contents into the ileum.
In kinesiology, the ICV is commonly found to be malfunctioning: often it is inappropriately open and occasionally it is inappropriately closed. The causes of such dysfunction are considered to be food sensitivities, intestinal acid/alkaline imbalance, psychological stress, and adrenal gland dysfunction.
When the ICV is inappropriately open, toxic colonic waste can regurgitate into the ileum from where it can readily be absorbed. Thus an open ICV leads to symptoms of autointoxication, which include headache, dizziness, faintness, nausea, and general achiness. Such symptoms bear a close resemblance to those attributed to Candida, and the relationship between these two conditions therefore needs clarifying.
Certainly it seems wise to check for Candida overgrowth whenever the ICV is found to be dysfunctioning, and conversely to check for a dysfunctioning ICV whenever Candida overgrowth is found. So one can cause or exacerbate the other, and both conditions can independently result in autointoxication from the bowel: Candida because it increases the permeability of the intestinal mucosa; and an open ICV because it allows colonic matter to reflux into the ileum. And of course, either condition can be mistaken for the other.
Parenthetically, testing suggests that intestinal parasites other than Candida (nematodes, protozoa) can also disrupt the functioning of the ICV. As with candidiasis, parasitosis can present a diagnostic challenge, and a short trial of an appropriate therapeutic agent (see section entitled Improving the intestinal milieu) may be the best way of proceeding when parasitosis is suspected.
Treatment - Anti-candidal therapy
There is no shortage of natural anti-candidal substances. Indeed, we have identified more than 50 food supplements possessing such activity. With this array to select from it is always possible to guarantee good results, although in difficult cases it can take 6-9 months to eliminate Candida overgrowth, instead of the usual 4-6 months.
Favourite anti-candidal supplements include Oxypro, CC 6, and CAN1F. Oxypro consists of hyperoxygenated saline, which unlike hydrogen peroxide, appears to be a totally benign substance and, being a liquid, is invaluable for the treatment of children, who often are unable to swallow capsules. CC 6 is a herbal combination, lovingly prepared by Marcia Howell. CAN1F similarly combines various antifungal herbs, and these have been selected for their collective ability to access all body sites that may harbour Candida and to deal with all of the different strains commonly encountered.
In fact, CAN1F has simplified the treatment of candidiasis enormously. It is often found that several supplements had to be combined in order to achieve the spectrum of activity that are needed to eliminate Candida overgrowth completely. In all but the most complicated of cases, it may be possible to abandon this tedious procedure. It has been found that resistance to individual supplements can sometimes develop, necessitating a change of supplement half-way through treatment. This hardly ever occurs with CAN1F, presumably because of its highly composite nature.
Defusing Candida toxins
Candida toxins are undoubtedly the cause of much of the symptomatology associated with candidiasis. Pre-eminent among these is acetaldehyde, which poisons by irreversibly binding to tissues and destroying them by free-radical activity.
Whilst it takes some months to eliminate Candida overgrowth, it is often possible to lower the level of Candida toxins quite quickly, and to achieve this CTX8 alongside the anti-candidal treatment is helpful. This formula contains herbs that support appropriate eliminatory pathways, and is also an antioxidant formula. (One lady who was suicidal actually claimed that CTX8 saved her life by lifting her Candida-induced depression within a matter of days.)
Additionally, depending on the level of Candida toxins it might also help to give zinc in ultra-pure form (NS 1) and molybdenum since the enzymes that degrade acetaldehyde (aldehyde dehydrogenase and aldehyde oxidase) are dependent on these two minerals. In theory, taking a fibre supplement should help lower the level of Candida toxins in the intestine by binding them and by encouraging frequent bowel movements. In practice, however, fibre supplements may not be well tolerated in those suffering from established candidiasis and/or a toxic bowel, perhaps because they stir up toxins by stimulating bowel motility, leading to their increased absorption. Fibre supplements should therefore be introduced with some care, and taken along with plenty of water to assist in the detoxification and excretion of any mobilized toxins.
In the brain, acetaldehyde interferes with cholinergic mechanisms, inducing a relative shortage of acetylcholine (which produces problems with thinking, reading, concentration, memory, and behaviour), and this can sometimes be helped by giving dimethylaminoethanol (DMAE), a choline precursor that readily penetrates the blood-brain barrier, and vitamin B5, which is necessary for the acetylation of choline.
Additionally, cross-crawl techniques are useful to re-establish left-right brain coordination impaired through acetaldehyde-induced corpus callosum dysfunction.
Preventing Candida "die-off"
When treating candidiasis it is important to minimize the so-called "die-off" (Jarisch-Herxheimer) reaction, which can result when large numbers of Candida cells die, break open, and release their toxic contents. Such a release of toxins and cellular debris can temporarily exacerbate any pre-existing symptom that is Candida-related, especially fatigue, bloating, headache, and general achiness. Additionally, histamine-induced reactions can occur at infected sites as a result of an immune response to dead Candida cell-wall proteins. Such reactions are most troublesome at mucous membranes.(3)
It is particularly important to prevent a die-off reaction in those suffering from certain serious conditions that may be Candida-related. Such conditions include multiple sclerosis, asthma, epilepsy, cardiac arrhythmias, depression, and arthritis. Any exacerbation of these conditions is unacceptable, and great caution must be exercised in these circumstances.
Candidal vaginitis ("thrush") is a common and sometimes distressing condition that affects about 20% of all women. It should be regarded as a symptom of intestinal/systemic candidiasis rather than a separate entity, and will generally respond to intestinal/systemic anti-candidal therapy and immune enhancement measures. Nonetheless, local treatment is often indicated, and we generally advise the use of tea-tree oil pessaries, or douching with herbs (CC 41) or diluted Oxypro, followed by lactobacilli (yogurt or Cervagyn cream). Acidifying the vagina with a vinegar bath (half a cup of white vinegar in a shallow bath) or cleansing the vagina with a salt bath (half a cup of table salt in a shallow bath) can be very helpful, as can restricting dietary sugar and dairy produce (lactose).
Interestingly, vaginal thrush can initially worsen or even appear for the first time once intestinal/systemic anti-candidal therapy is started. The cause of this phenomenon is not clear; perhaps it results from a temporary deterioration in immune status arising as part of the die-off reaction.
Candidal or other fungal infections of the skin will likewise usually respond to systemic anti-candidal therapy and immune support, and similarly, local treatment can speed up resolution of the problem. We use tea-tree oil cream, black walnut tincture, or diluted Oxypro.
Correcting ICV dysfunction
Eliminating Candida overgrowth will do much to restore ICV dysfunction, both by removing Candida from the valve and by helping to stabilize emotions. Kinesiology employs a number of physical or energetic corrections that can be helpful, some of which can be taught to the subject. Certain herbs support ICV function, and these have been combined in ICV31, which we resort to if the dysfunction is particularly troublesome or painful.
Improving the intestinal milieu
Inadequate production of digestants (gastric acid, pancreatic enzymes, and bile) is common and predisposes to intestinal candidiasis. Our initial approach here is to give betaine hydrochloride and digestive enzymes. If digestion improves with such replacement therapy we then feel justified in initiating a long-term program designed to rebuild and rejuvenate the organs of digestion using appropriate nutrients and herbs such as stomachics (HCL17) to encourage hydrochloric acid production, appropriate digestive alteratives (PAN14) to support the pancreas, and cholagogues/hepatics (HCH27, HEP28) to enhance bile flow.
If Candida overgrowth is to be held in check in the colon, it is necessary to deal with the intestinal dysbiosis that is almost invariably present in those of us subsisting on a western diet. Literally, dysbiosis means a "state of bad life" and this term is used to describe the imbalance between desirable and undesirable bacteria that can occur in the ileum and colon. This is a large and important topic, and readers are referred to the excellent texts by Leon Chaitow & Natasha Trenev(20) and Dr Nigel Plummer.(21)
Our own approach to treating dysbiosis involves the use of anti-microbial herbs (DYS6) to reduce the population of undesirable bacteria in the colon, together with the probiotic bacteria Lactobacillus acidophilus and Bifidobacterium bifidum. We subscribe to the view that human-derived probiotics are preferable to the immunologically less acceptable bovine-derived varieties, and accordingly usually recommend only the former (Bio-Acidophilus, Bifido-Acidophilus, Acidophilus Supreme).
Dysbiosis and digestive insufficiency encourage intestinal parasites other than Candida. These include enteroviruses, protozoa, and nematodes. Enteroviruses, if allowed to establish themselves in the colon can spread systemically to cause a myalgic encephalomyelitis (M.E.) situation. Protozoa and nematodes can cause a whole array of intestinal and systemic symptoms, and all three types of infection activate and burden the immune system. We use anti-infective and immune-stimulating herbs (VIR49) to help deal with viruses; anti-protozoal herbs (Artemisia complex, Liquid Biocidin, or PRO34) to help deal with protozoa; and vermifuge herbs (CC 14, PARA20 or NEM40 to help deal with nematodes.
Rebuilding the immune system
If candidiasis is regarded merely as a symptom of a weak immune system, the importance of attaining immune competence is at once apparent. Relevant nutrient deficiencies need identifying and addressing, including those caused by Candida (see next section); mercury overload needs eliminating in those with amalgam fillings (we use MERC30, which contains appropriate detoxifying herbs, together with yeast-free selenomethionine and selected amino acids); psychological stress needs to be reduced (we use HKLM15, which is a combination of herbal nervines, NSV9, which is a mixture of flower & gem resonances, and kinesiological techniques); and geopathic and electromagnetic stress needs combatting.
It should be remembered that the liver and the adrenal glands constitute important components of the defence system, and these should be supported if necessary.
Food allergens represent a burden on the immune system, and these should be identified and eliminated. Apart from assisting immune recovery, this measure will often substantially reduce overall symptomatology. (Generally speaking we do not find it necessary to impose the severe dietary restrictions recommended in most anti-candidal texts: removing dietary allergens together with sugar is usually quite adequate provided that the correct anti-candidal supplement is being taken at appropriate dosage.)
In an average case only a few of the above measures will need to be implemented, and where the budget is particularly restricted, we often merely give IMU9, which is a combination of immune-stimulating herbs, and remove allergens from the diet.
Correcting nutritional deficiencies
For reasons that are not entirely clear, candidiasis is associated with a number of nutrient deficiencies. These include vitamin A, pyridoxal phosphate, magnesium, zinc, and Omega-6 and Omega-3 fatty acids.
One unifying hypothesis is that acetaldehyde displaces pyridoxal phosphate from its binding sites on albumin, resulting in its rapid metabolism. Since magnesium and zinc appear to be dependent on pyridoxal phosphate for their assimilation, this could lead to a deficiency of these minerals. In turn, this would further deplete pyridoxal phosphate, and also deplete the phosphate coenzyme forms of vitamins B1, B2, and B5, since phosphate transfer is a magnesium-dependent process. Additionally, the enzyme delta-6-desaturase is dependent on pyridoxal phosphate, magnesium, and zinc, so the conversion of cis-linoleic acid to gamma-linolenic acid (GLA) and of alpha-linolenic acid to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) would be inhibited by a deficiency of these co-factors.
Alternatively, it could be argued that the magnesium deficiency is "primary" (itself resulting from impaired renal reabsorption of magnesium consequent upon chloride retention due to the binding of chloride by leukotrienes produced as part of the inflammatory response to Candida).(4) The magnesium deficiency could then cause a depletion of the phosphate coenzyme forms of vitamins B1, B2, B5, and B6, with vitamin B6 being the most affected because pyridoxal phosphate formation is dependent on riboflavin (vitamin B2) phosphate and zinc (depleted as described above), in addition to magnesium.
With regard to vitamin A deficiency, it is theorized that the conversion of carotene to vitamin A is inhibited by Candida-induced hypothyroidism or by Candida-induced impairment of carotene dioxygenase in the intestine or liver.(4) It may be relevant that Candida binds iron, and that carotene dioxygenase is an iron-dependent enzyme.
Whatever the mechanisms of these deficiencies, they should all be investigated and corrected where appropriate, particularly since they undoubtedly contribute to the symptomatology of candidiasis. In view of the preceding considerations, vitamin A deficiency should be corrected with retinol rather than with carotene, and the pre-formed coenzyme forms of the B-vitamins should be preferred to the usual precursor forms.
Magnesium is a vitally important mineral, a deficiency of which can lead to multiple biochemical and physiological perturbations, including immune impairment. It is, at the best of times, a difficult mineral to replete. As well as eliminating Candida overgrowth it is essential to give magnesium in a form that is well absorbed. Over the years it has been found that magnesium citrate is one of the most bioavailable forms of magnesium but noted that citrus-derived magnesium citrate is not always acceptable to those intolerant of citrus fruit. Nowadays we therefore normally use only non-citrus-derived magnesium citrate (NS 4). However, while this is an effective and inexpensive form of magnesium for most people, there is a significant minority for whom it is not adequately bioavailable. To overcome this problem, two other organic salts of magnesium have been combined with the citrate to form a complex (Magnesium Supreme) that tests as being highly bioavailable in all subjects.
Healing the leaky gut
As stated earlier, Candida overgrowth (and doubtless that of other intestinal parasites) damages the intestinal mucosa, leading to the leaky gut syndrome. As well as encouraging food allergies to develop, a leaky gut facilitates the absorption of toxins from the bowel. Besides stressing the eliminatory organs, the resulting toxaemia is likely to give rise to minor symptoms such as headache, dizziness, faintness, nausea, and acne, and also is implicated in the causation of a number of major conditions including thyroid disease, ulcerative colitis, Crohn's disease, pancreatitis, lupus erythematosus, allergies, asthma, and psoriasis.
Environmental allergies and chemical sensitivity may well fade once Candida overgrowth has been eliminated, and immunity thereby enhanced, but this is much less likely to occur with food allergies; here, it is essential to heal the leaky gut (which in any event should be addressed in order to minimize autointoxication). We use LKY10 (a combination of intestinal vulneraries) as the main agent to achieve this, perhaps along with aloe vera juice, N-acetyl glucosamine (NAG) or Enteroplex.
The foregoing represents a holistic and fairly exhaustive approach to the treatment of candidiasis, which of course, is not necessary in every case: often we do no more than give a single anti-candidal supplement for a few months. However, as Pasteur eventually realized, it is the terrain not the germ that is important, and unless the factors that caused Candida to overgrow in the first place are modified, candidiasis can return with astonishing speed.