Candida - A Different Approach: An Interview with Dr. Gruia Ionescu, PhD
Originally from Romania, Dr. Ionescu defected to the West via Canada, in 1979. He earned his doctorate in biochemistry and immunology in West Germany, 1983. Currently he is Scientific Research Director of the Spezialklinik Neukirchen in Bavaria (southern West Germany). This clinic specializes in allergic and degenerative diseases.
MJ: Please explain why we (with food allergies) need to concern ourselves with Candida albicans?
GI: Candida infections are quite likely responsible for many of the persistent symptoms allergic persons experience. If recovery were simply a matter of food selection, then anyone omitting his offending foods would be well. But such is not the case.
Most people with allergies experience other health problems, too. This is why we now call the diagnosis "CRC" (Candida-Related Complex). We have found approximately half of our allergies have a problem with Candida over-growth in their gut. And many people diagnosed with Candida infections exhibit intolerance to foods, also.
MJ: Tell us about your work at Neukirchen.
GI: We have treated over 5,000 in-patients and 12,000 out-patients, most of whom are "atopic" patients. This means that upon examination of the blood, they carry high levels of IgE antibodies and increased eosinophil counts.
Patient diagnoses include atopic eczema, seborrhoeic eczema, psoriasis, allergic asthma, allergic rhinitis, hayfever - and in children, hyperactivity. Common findings of this syndrome include all kinds of digestive disorders, such as the following:
Lactase deficiency (and lactose intolerance)
Fatty stools with high levels of short-chain fatty acids resulting from fungal metabolism of carbohydrates
Deficiency of digestive enzymes
Very disturbed nutritional pattern with food intolerances (in most patients) We also look for a certain pattern of biochemical findings in the blood that typify this condition:
Low levels of total proteins in the blood (from poor protein digestion)
High levels of phenol in the blood (due to faulty metabolism in the intestine)
High antibody levels of Candida, and other yeasts and molds
By the time patients have several of these disorders, they complain of many gastrointestinal symptoms - bloating, constipation, flatulence, passing undigested food, etc. Poor nutrition -- that is, poor digestion and malabsorption, with most of the manifestions I've mentioned -all lead in time to a dysfunctional immune system.
MJ: Please summarize how your approach differs when treating those many digestive problems.
GI: In our clinic in West Germany we focus our attention on improving the health of the gut - especially its lining, the intestinal mucosa. Here's an overview of our rationale:
When the gut contains an overgrowth of Candida, the lining becomes very inflamed and less efficient at handling food. Because the walls become more permeable, they start to leak. Many terms have evolved to describe this condition - "Leaky Gut Syndrome," "Contaminated Small Bowel Syndrome," "Intestinal Dysbiosis" and "Increased Permeability" among them.
With the gut not doing its job as well in this state of acute inflammation, the lining allows undigested particles of food to pass through it into the circulating blood. (It should only permit nutrients to pass into the bloodstream.) It's not unlike a dam that springs multiple leaks.
DIAGRAM): Healthy Gut Only nutrients pass through
DIAGRAM): Inflamed (Sick) Gut Particles of undigested food
The body's immune system identifies the particles as foreign "invaders" and attacks them. And when the body attacks bits of circulating foods, pollens or other non-toxic substances in this way, different types of allergic reactions may result.
MJ: But does your emphasis on the health of the gut effect your treatment for the above condition?
GI: We've found that the best diet in the world will not give the patient adequate nourishment if he has abnormal bowel flora. In healthy people beneficial bacteria predominate in the delicate balance of organisms. They prevent the pathogenic bacteria, yeast, fungi or mold from running rampant.
We identify many more pathogens than just Candida albicans and other yeasts and molds. We also culture for many disease-causing bacteria. We determine the precise levels quantitatively with the aid of computers.
We know that stool cultures don't reveal all organisms present, especially the ones that live in the small bowel. So sometimes we even aspirate the contents of the duodenum to test it for microbial contaminants.
We focus on the small bowel so much because it's where much of digestion and absorption take place. Our treatment simply tries to normalize the balance of micro-organisms in the gut.
I feel it is a mistake to give nutritional supplements this early in the treatment. For example, if the patient takes B-complex vitamins at this stage, they can do more harm than good. The pathogens would utilize the vitamins for themselves and they actually gain strength, multiply and flourish!
MJ: That sounds like a "double whammy." Not only do the patients not benefit from the supplement, but the colonies of yeast that they're trying to knock out actually get stronger! No wonder some patients feel so bad.
GI: Exactly. Besides the inflamed gut, we often find that the normal digestive enzymes have become inhibited and dysfunctional. This happens because the acid -alkaline balance of the intestinal tract is altered so the enzymes are inactivated. Thus, the patients will experience malabsorption, bloating and the other signs of poor digestion just mentioned.
To minimize this, we start by correcting the population of organisms in the intestinal flora to a more healthful balance. We have two goals here - 1) to destroy or substantially reduce the pathogens, and 2) to supplement the beneficial organisms with replacement therapy.
To destroy the pathogens: During this first phase we give a short course (2-3weeks) of an appropriate antibiotic or antifungal medication. We base this on the results of culture and sensitivity studies that evaluate 30 to 35 drugs for their effectiveness against the patient's specific pathogens. In Germany we have 18 antifungal drugs to treat with and some (such as natamycin) are much more effective against yeasts and molds than nystatin.
For replacement: We suggest Klaire Lab's Vital-Plex for the necessary acidophilus and bifidobacteria. Initially we use rather high doses - 1 teaspoon three times daily. For the same reason, we also use Colibiogen - a drug available in Europe but not in the United States. It replaces harmful strains of E. coli with healthy, beneficial strains.
We also use herbal remedies (echinacea from the composite family, for one) to help restore the cellular immunity, and to prevent a recurrence of the infection. Or we may neutralize the patient against specific, pathogenic strains of microorganisms.
We combine the above therapies with individualized diets. In severe cases where the gut is very inflamed, in order to allow it to heal we may use a semi-liquid, elemental diet. Sometimes, though rarely, we even switch to intravenous feedings for several days.
MJ: Do you fast your patients in the beginning?
GI: No. We use what we call a "reduction" diet for one week. This includes only one food - usually boiled rice, noodles or white potatoes and tea. We do this because most of the patients who come to our clinic are acutely ill, with high levels of histamine in the blood. Testing in that state is not accurate or satisfactory.
MJ: But those may be allergenic foods. Don't they trigger reactions?
GI: Not usually. Most atopic, patients react more to ingesting many foods simultaneously. We find that they tolerate a single food very well. But if necessary, we may suggest sweet potatoes as an alternative for their week of one-food meals.
One week on the reduction diet enables the patient's body to recover from such an extremely reactive state. We instruct patients to follow the reduction diet at home for a week before they are admitted (on the eighth day of their diet). The histamine, prostaglandin and leukotriene blood levels should all have dropped in that time. Meanwhile, the mast cells in the intestinal walls are storing up histamine, getting ready to "fire" (in an even stronger reaction) the next time an allergen is eaten.
Now we test the patient with many foods to see if and how they react. We do this with a special panel of 25-30 common foods - all precisely measured and quantified allergenic foods. We call this the "challenge meal" (CM). The patient has a CM twice in the same day.
The IgE level of antibodies peaks 18-24 hours following the first CM, so we monitor what's happening with a blood test 24 hours post feeding. This helps us get a very good correlation between patient symptoms (in reaction to one or more of the foods) and the levels of antibodies we find in the blood.
MJ: Do you mean that all 30 or so foods are fed at the same time?
GI: Yes,. They are fed in the same meal, at about 10-15 minute intervals.
MJ: But if the patient reacts to consecutively eaten foods-milk, beef, some kind of fish and eggs for example - how can you sort all of that out?
GI: We see the first reaction at the beginning of the meal and the others we find specific antibodies in high concentration in the blood test.
In our experience, the highest frequency of positive reactions occurs against grains, milk and dairy products, nuts, and brewer's yeast.
In that first blood sample that we draw at 24 hours, we usually find high concentrations of specific IgE antibodies against specific foods.
Statistically, we have noticed that atopic eczema patients react to an average of 8-12 different test foods. But the number of reactive foods may range from 2 to 25. Plus, some will react to external substances - gasoline, perfume, pollens, dust mites, dust, etc.
We feel that our technique of testing with a CM offers certain advantages. First, we are able to eliminate a large number of false negative reactions that turn up in fasted patients.
MJ: What do you mean, "false negative?"
GI: This occurs if we're testing a patient who had recognized that a food disagreed with him and had avoided it for a few years. If we test him without a challenge, we'll get negative results because his body hasn't had to produce those antibodies lately. But if he resumed eating that food freely, he would again develop symptoms. That's why we call this a false negative -and why we use the CM technique.
It's comparable to testing the body's ability to produce insulin by challenging it with a high-sugar meal or beverage.
A second advantage of our approach is that after identifying the patient's allergens we can put together a diet that omits them - we call this an exclusion diet. I believe your name for it is the elimination diet.
Actually, I've described only one way that we test for allergies. We also use another method. We measure the circulating immune complexes (CIC), too. Remember our discussion about the leaky gut wall? Now I'm speaking of estimating the amount of food particles that passed through by measuring the level of IgG -containing CIC (another marker of allergy). IgG-CIC values may be increased by 300%! Our clinic is currently engaged in a study to clarify the clinical relevance of food specific IgG levels in delayed reactions.
MJ: Before we get away from your plan of treatment can you tell us about the second phase of therapy?
GI: Of course. We continue patients on their special diets for 6-8 months. In this second phase of treatment, we start nutritional supplements. It is extremely important to do this in the proper order. The supplements are individually determined by laboratory testing.
By this time the patient has been dismissed from the clinic and is learning to manage his diet at home. However, we monitor his progress with stool and duodenal aspirate cultures and other testing as indicated. The gut flora must remain normal for many weeks and months for us to close the case and consider the patient well.
Our experience is that after 6-8 months of treatment most of our patients can return to eating a normal diet again.
MJ: Tell us more about your anti-Candida diet.
GI: In our clinic we offer a lot of salads and vegetables to our in-patients. We serve fish and chicken only twice a week, and we serve no beef or pork. We avoid pork even if the patient isn't allergic to it because we feel the amino acids don't occur in a beneficial balance. Also, pork meat is very rich in histamine. Both meats are difficult to digest and can cause multiplication of the putrefactive bacteria.
We use a diet high in fiber and complex carbohydrates - but not too many simple starches, and no yeast breads. We only permit fresh fruits such as bananas, peaches, papaya or pineapple, with their natural enzymes. We don't serve citrus fruits at all because so many people react to them.
We serve only fresh fish, never frozen. Freezing increases the histamine level up to ten fold! We have tested and measured this, and feel it's an important (often overlooked) factor in whether a person can tolerate a specific fish or not.
Our patients eat large amounts of live-culture yogurt - at least a pint a day. We serve this even though many of them have become lactose intolerant and don't digest most forms of milk. The yogurt is milk in its most digestible form, and the Lactobacillus acidophilus is just so beneficial that if they can handle the yogurt at all, we want them to eat it.
Our nutrition department gets copies of each patient's lab work. This enables them to plan individual diets and eliminate the offending foods, as identified by the RAST, CIC and food specific IgG tests. They then rotate their permitted foods as you do in this country.
We teach our patients some important techniques in eating that may be new to them: In order to prevent diluting the digestive enzymes, we ask patients to omit water or other liquids with meals, but to drink 2-3 liters of mineral water or tea between meals. Further, we teach them to aid their digestion by eating small portions more often - slowly - and to chew their food thoroughly.
MJ: When I heard you speak, you mentioned "pseudo-allergies." What are they?
GI: Years ago researchers discovered tell-tale markers in the blood which they designated as IgE antibodies. They found that these antibodies were often present in their sensitive patients who reacted to foods or environmental factors (pollens, dust, etc). They decided that the presence of IgE antibodies would define "allergies." To this day, that is the classic criteria for true allergies.
As it turned out, IgE is only one type of antibody sensitive patients may have. After IgE was identified, lab tests became more sophisticated and researchers identified other types of antibodies which also occur with allergic reactions. Still, many physicians remain adamant that only the presence of IgE antibodies reveals true allergies.
I use "pseudo-allergic" reaction (PAR) to describe the non-immunologic reactions that occur in direct response to a food. That is, the pathogenic organisms in the patient's gut obtain their nourishment from the food that the patient eats. Then they, give off toxic waste products. The patient then reacts to the toxins (sometimes called mycotoxins or endotoxins) rather than directly to the food eaten. Or they may react to other products of microbial metabolism such as indol, phenol, short chain (volatile fatty acids, biogenic amines, etc.)
Another form of PAR occurs when a person reacts to the additives in the food -such as colors, flavors, preservatives, or pesticides - rather than to the food itself.
Viewed in this way, it's easy to understand why we focus our treatment on the gut. When the intestinal mucosa heals, the patient should react less intensely and to fewer allergens. He may even seem not particularly reactive any more.
[Editor's Note: Pseudo-Allergy is an accepted European medical term used to describe non-IgE reactions. It does NOT mean that the sensitivities or reactions of pseudo-allergies are any less real. Some physicians in this country choose to call the non-IgE reactions "sensitivities" or "intolerances." Perhaps one day the terminology will become more standardized.]
In any case, PAR isn't something to worry about. If you react to allergens, you're allergic. The actual mechanism for not tolerating a food is more of a technicality for physicians to debate and discuss. But from the patient's point of view, perhaps the terminology is unfortunate.
MJ: Do you have anything you want to add, Dr, Ionescu?
GI: We are glad to see that similar approaches in the diagnosis and treatment of chronic skin disorders and allergies are getting more acceptance world-wide. For instance, our colleagues from the Frankfurt/Main Medical School recently published results confirming intestinal contamination with Candida albicans in their patients with seborrhoeic eczema and psoriasis. They also report positive results after anti-fungal therapy. It is my understanding that the USA anti -fungal therapy is already being used for psoriasis.
Although private, our clinic is recognized by the German Ministry of Health and by the German National Insurance, for compensation. This allows every patient here who needs it, to benefit from these new, more effective approaches to therapy.
To correspond with Dr. Ionescu:
Reprinted from Mastering Food Allergies Newsletter, 2615 N. 4th St., #616, Coeur d'Alene, ID 83814. Subscriptions $20 in U.S., $25 in Canada.
By Marjorie Hurt Jones