Candidiasis is a fungal infection caused by candida. Candida albicans,  the most common type, can be found in the gastrointestinal tract, mouth, genital or urinary tract. Candida albicans is naturally part of the microflora when it occurs in small amounts, but in some cases can result in overgrowth. Symptoms may vary from person to person, but common symptoms include bloating, brain fog, white tongue, eczema, abdominal pain, anxiety, constipation, depression, and acne.

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CC: Constipation, Stomach Aches, Behavioral Concerns

Sean was a 5-year-old boy who dealt with constipation and stomach aches, and his mother was concerned with his behavior. Sean would have one bowel movement every 3-4 days. His stomach aches were daily and were associated with eating, but his mother could not pinpoint what foods made him worse.

The patient's mother denied bloating and reflux but reported Sean having excessive gas. Sean's mom was concerned about anxiety as Sean did not adjust well in social situations and would need a warning if they were going somewhere he was unfamiliar with. Sean's mother was also concerned with Sean's behavior as he would have surges of anger in situations where he would be asked to complete an everyday task. Based on her research, she was concerned about PANDAS, OCD, or ADHD but had no official workup yet. Mom noticed that Sean liked to keep things messy, and if she cleaned up, he would put everything back in the exact place that it was.

She was desperate for answers, and though he was not on any current prescription medicines, she wanted to keep it that way. He had difficulty concentrating and had a tough time expressing his emotions. During the first appointment with Sean, he did not want to make eye contact and seemed disinterested.

Additional History

The patient had a history of eczema (at age 1), in which his mother put him on a gluten-free diet which helped with eczema. However, the patient still ate processed foods like cheerios with almond milk, gluten-free pizza, and gluten-free mac n’ cheese. He loved eating sweets and preferred not to eat vegetables.

The patient had issues sleeping through the night and would wake up 2-3 times per night but would fall back asleep easily.

Initial Labs

MDL Lyme + Coinfections Profile:

• Negative

Comprehensive Stool Test Results:

• Candida albicans: high
• Lactobacillus: no growth  
• % Acetate: low
• % Propionate: low
  

Lab Analysis

Sean's lab work ruled in/out potential differentials.

Co-Infection Markers

Negative for strep antibodies and Lyme + co-infections markers. Markers were run as the mother was concerned with PANDAS. The patient did demonstrate OCD behavior as well as bouts of anxiety/anger. The patient had a low CD57 count, a molecule found on the surface of Natural Killer cells (NK cells). They are vital for fighting pathogens, and when low, immune system irregularities may be found. These markers are commonly associated with Lyme disease, but not always. Even with negative strep antibodies and Lyme panel, the marker CD57 can still be low, which could indicate a low-functioning immune system.

Low Nutritional Markers

Labs showed low nutritional markers such as iron, omegas, and vitamin D, which could be associated with low dietary intake or low absorption due to inflammation of the gastrointestinal tract.

Evidence of Inflammation

GlycA was mildly elevated, which indicates systemic inflammation.

Imbalanced Gut Microbiome

Comprehensive stool analysis showed levels of candida albicans and low levels of beneficial bacteria such as Lactobacillus. Based on the other negative lab findings, Candidiasis was speculated to be the root cause of the patient's health concerns. The treatment plan focused on treating and healing the gut.

Interventions

• Started patient on liquid fish oil (1-2 teaspoons daily) to increase omega levels.
• Started patient on liquid d3/k2 (3,000 IU daily) to increase vitamin D levels.
• Started patient on caprylic acid at 400 mg 3x/day. Started patient on grapefruit seed extract at 250 mg 2x/day. Both were used to eliminate the candida albicans.Agents were utilized as the stool sample cultured the candida albicans and provided a list of agents that the fungus was most susceptible to.
• Started patient on an anti-candida diet. Continue diet/supplements for 8 weeks.

At eight weeks, the patient had a follow-up. All symptoms were reevaluated, and because the patient was doing very well, the patient was taken off the anti-candida diet and the caprylic acid and grapefruit seed extract.

The patient's mother requested another stool test to confirm candida albicans was no longer there. In the meantime, the patient started taking probiotics (Biotic Daily T) that contained high levels of lactobacillus and other beneficial strains and GI Core (L-glutamine, zinc, vitamin A, aloe vera, DGL) for 60 days. This was done to help support the tight junctions (desmosomes) in the gut to treat leaky gut.

Mom was given strict directions for food reintroduction, to add in foods very slowly to see if any foods aggravate Sean, and watch for changes in bowels/pain and behavior or sleep changes. Mom was educated on making healthier choices, including adding more organic whole foods and avoiding dyes, preservatives, and processed sugar.

Follow Up 3 Months Later

MDL Lyme + Coinfections Profile:

• Did not run

Comprehensive Stool Test Results:

• Saccharomyces boulardii: high
• Candida albicans: negative

At our follow-up visit two months later, Sean was feeling much better. The mother reported daily bowel movements, no excessive gas, no abdominal pain, and much better sleep. Anxiety around social situations was 80% better. Mom stated that Sean was now the calmest of her three children, and she couldn't believe it.  

At three month follow-up, gastrointestinal symptoms did not return, despite adding foods back in. Sleep and anxiety were still much improved. Sean was also not getting angry easily, other than in warranted situations.

Stool analysis and labs were reviewed: Nutritional levels normalized, and stool samples showed the absence of candida albicans. Levels of Saccharomyces boulardii were identified, but they were in Sean's probiotic so that was not a concern.

Summary

This case demonstrates how powerful the gut-brain relationship is. An overgrowth of candida albicans in the gut caused not only gastrointestinal symptoms such as stomach pain and constipation but had an effect on the brain and behavior.

The gut is commonly described as the "second brain," so by addressing gut concerns, many behavior concerns improve. The gut produces 400x more melatonin than the pineal gland, in which by treating the gut, in some cases, better sleep can also be achieved. By treating the root cause, candida albicans, and healing the gut, the patient could absorb nutrients better and was now thriving in situations that used to be problematic for him