Speaker 1: Let me take you back to when I was a weird,
Speaker 1: nerdy fourteen year old. I'd recently started menstruating and was
Speaker 1: incredibly self conscious about managing my periods At school. The
Speaker 1: popular girls would congregate in the school bathroom, so they'd
Speaker 1: hear the unzipping of my bag and the crinkle as
Speaker 1: they unwrapped sanitary products from their packaging. I was terrified
Speaker 1: about what gossip would be sped around school if people
Speaker 1: found out that time was on my period. I made
Speaker 1: the decision to avoid changing my sanitary products at school.
Speaker 1: This created a lovely, warm, moist environment for yeast, so
Speaker 1: it's no surprise that I got a yeast infection or thresh.
Speaker 1: If you have not had the pleasure, it's like an
Speaker 1: infected horsefly bite. It's an incessant itch that is constantly
Speaker 1: screaming for attention. I couldn't sleep, It hurt to pee,
Speaker 1: I couldn't concentrate on anything except for the pain of
Speaker 1: the itch. This coped with being a teenager with hormones
Speaker 1: coursing through my body. The shame and self loathing of
Speaker 1: my poor decision made this a really distressing time. To
Speaker 1: add to my humiliation, I had to tell my GP
Speaker 1: about my symptoms, but I lacked the polite vernacular to
Speaker 1: do so. I eventually stammered that I had an itch
Speaker 1: at the front of my bum, and the GP took
Speaker 1: pity on me and my mum was able to take
Speaker 1: over the consultation. I was asked no further questions and
Speaker 1: no invasive tests were performed. I was given a prescription
Speaker 1: for Caniston, and this was the first time I had
Speaker 1: ever used a pessary and had no idea whether I
Speaker 1: was in certy in correctly. However, I recovered and became
Speaker 1: scrupulous about my vaginal health and changed my sensory products
Speaker 1: at least every four hours, as recommended. Fast forward abound
Speaker 1: ten years. I'm in a sexual relationship and I get
Speaker 1: the itch. I assume it's thrush and get Caniston over
Speaker 1: the counter at the pharmacy and carry.
Speaker 2: On with my day.
Speaker 1: The thrush clears up for a while, but then it
Speaker 1: comes back, so I called the GP and they tell
Speaker 1: me to go to the sexual health clinic. To do this,
Speaker 1: I have to take annual leave to travel there in
Speaker 1: the opening hours. Even then, the only accommodated walkins, so
Speaker 1: I may not have been seen. If these barriers were
Speaker 1: not enough. I was also extremely embarrassed with dou whole
Speaker 1: idea of going to a sexual health clinic. Eventually, I
Speaker 1: saw a GP who gave me a swap and confirmed
Speaker 1: I did have recurrent thrush. My partner at the time
Speaker 1: laughed and told me that thrush was no big deal,
Speaker 1: which is probably because he.
Speaker 2: Couldn't catch it.
Speaker 1: Because my thrush was recurrent, the GP gave me a
Speaker 1: blood test for diabetes, which came back negative. There was
Speaker 1: no obvious cause, so I fell through the cracks a
Speaker 1: little bit.
Speaker 2: The GP had never asked about my environment.
Speaker 1: If they had, we probably would have figured out the
Speaker 1: cause pretty quickly. In the office, my desk was positioned
Speaker 1: directly underneath the air con and I really feel the cold,
Speaker 1: so the office administrator had very kindly given me a
Speaker 1: little heater to put underneath my desk. I like to
Speaker 1: have it snuggle between my knees, which created a really
Speaker 1: lovely warm environment for myself.
Speaker 2: And also for the east. At the time, I didn't
Speaker 2: put two and ty together.
Speaker 1: I just carried on in discomfort for the next few months,
Speaker 1: with the added expense of Caniston on my regular shopping list.
Speaker 1: There were other knock on effects My sleep suffered, my
Speaker 1: relationship suffered. My partner at the time really struggled with
Speaker 1: the reduction of intimacy. So on the night when saying
Speaker 1: no wasn't worth the drama, I would scrab my legs,
Speaker 1: close my eyes and think of England as the saying goes.
Speaker 1: For those who haven't had the pleasure, it feels like
Speaker 1: having sandpaper shoved inside that whole spy bite described earlier.
Speaker 1: Several years later, I'm happily single, I work from home
Speaker 1: and can control my environment, and I am thrush free.
Speaker 1: I found thrush to be extremely isolating, and I hope
Speaker 1: that if anyone can relate to my story that they
Speaker 1: find comfort that they are not alone. Thank you very
Speaker 1: much for listening.
Speaker 3: You know, I feel like that story really, it like
Speaker 3: exemplifies some of the shame that's surrounding things like yeast infections. Yeah.
Speaker 4: Yeah, I feel like no one wants to talk about
Speaker 4: east infections, right.
Speaker 3: And I know that's so common. I'm gonna say, like
Speaker 3: literally every person with a vaginant with vagina has had
Speaker 3: a yeast infection.
Speaker 5: Seventy five percent actually almost every time. That is pretty
Speaker 5: much close to everyone.
Speaker 4: Yeah, yeah, yeah, Thank you so much for sharing your
Speaker 4: story with us and everyone listening.
Speaker 3: We really appreciate it. Yeah, thank you, thank you.
Speaker 4: Hi. I'm Aaron Welsh and I'm Aaron on An Updike and.
Speaker 3: This is this podcast will kill you.
Speaker 4: Welcome to yeast infections.
Speaker 3: And I mean east infections.
Speaker 4: It is broader.
Speaker 3: Yeah, well I feel like but it's all yeast or
Speaker 3: yeast like and so it's weird. Yeah yeah, and not
Speaker 3: just Canada ALBACNS Canada Orris Canada. Those are the only
Speaker 3: two I know right now. It's a point in our conversation.
Speaker 3: I can't believe we haven't done this.
Speaker 4: I can is simply too long. That's good, it was.
Speaker 4: Our list is long. And you know we're doing it now.
Speaker 4: That's all we can say. We're doing it now.
Speaker 3: I learned a lot, we're about to learn some more,
Speaker 3: and we're about to tell you about.
Speaker 4: A recipe for our quarantquarantine or please super rita today.
Speaker 3: Super rita. Yeah, actually this you can make it a
Speaker 3: quarantine if you want.
Speaker 4: Sure.
Speaker 3: It's called a cant Yeah.
Speaker 4: The candid shot or just a candid shot.
Speaker 3: Well, the only reason I was thinking a candid shot
Speaker 3: is because candid duh. And then what happens to that
Speaker 3: a we just move it over. But the candid shot.
Speaker 4: In your grammar I like it.
Speaker 3: I mean than a candid shot is fairly simple. It
Speaker 3: is like rose soda and rhubarb.
Speaker 4: I was gonna say, like, you just stand there and
Speaker 4: someone takes your pictures.
Speaker 3: Sorry, that wouldn't be candid. No, you're right.
Speaker 4: Any Ways, you can find them very complicated recipe for that,
Speaker 4: plus e Brita and if you want to add alcohol
Speaker 4: a quarantine on our website, this podcast will Kill You
Speaker 4: dot com and our socials? Are you following us on socials?
Speaker 4: Aaron's making videos of these drinks.
Speaker 3: Or poor videos. Yeah, not very good, but they exist.
Speaker 4: We're trying trying things things Instagram, TikTok, Facebook, website.
Speaker 3: Webs podcast will kill You, dot com transcripts, links to
Speaker 3: merch links to bookshot dot org, affiliate account, links to Goodreads list,
Speaker 3: links to music by Bloodmobile, the sources for each and
Speaker 3: every one of our episodes. There's also embedded YouTube videos there,
Speaker 3: so if you check out our oh you doing that.
Speaker 3: Sometimes I'm a little bit late because I have to
Speaker 3: wait for the day that they publish. It doesn't matter.
Speaker 3: They're there and some other things that contact us form.
Speaker 3: Thank you everyone who has submitted your story for a
Speaker 3: first hand account using our first hand account form.
Speaker 4: Just know it could be years before we contact you,
Speaker 4: but we read them all.
Speaker 3: But we do read them all.
Speaker 4: Yeah, yeah, I think great, that's it.
Speaker 3: You did a great job. Thank you.
Speaker 4: Do you want to hear about the biology of Canada?
Speaker 3: Of course I do.
Speaker 4: Let's take a break and get into it. So the
Speaker 4: star of today's show is a fungus, and as we've
Speaker 4: learned in previous fungal episodes, funk i tend to be
Speaker 4: a little bit complicated. They do, they really do. And
Speaker 4: in the case of Canada, often people cited as a yeast, right,
Speaker 4: we think yeast infection, and a yeast is a single
Speaker 4: celled fungus, right, like the kind of use that you
Speaker 4: use for bread. But Canada also exists as a filamentous
Speaker 4: mold with its little hiphi or sometimes pseudo hyphie branching out.
Speaker 4: So it's really quite multifaceted, and it might not be
Speaker 4: surprising that, in part because of that, Canada can cause
Speaker 4: a really wide range of potential infections, not just vaginal
Speaker 4: yeast infections. There are several different species of Canada that
Speaker 4: cause infections in humans, the most common of which is
Speaker 4: Canada albacans, but there are I think there's a push
Speaker 4: to group all of the other ones as like non
Speaker 4: albacans Canada or none nac and acy non albcans Canada yeast. Anyways,
Speaker 4: and these actually some of them have been growing in
Speaker 4: abundance and posing a growing concern to infectious disease specialists
Speaker 4: and in public health official and infection preventionists in hospitals.
Speaker 3: Well, because that's what I was wondering, So why would
Speaker 3: you like, are all non albacans Canada as pathogen like
Speaker 3: equally pathogenic and problematic?
Speaker 4: All of them tend to be more apt to resistance,
Speaker 4: which is one of the big concerns about them.
Speaker 3: Yeah, very interesting.
Speaker 6: Yeah.
Speaker 4: So the kind of most notable ones, and there are
Speaker 4: more than these two, but kind of the most notable
Speaker 4: ones are Canada Orus and we'll talk more about that later.
Speaker 4: And then what used to be called Canada glebrata but
Speaker 4: what is now has been reclassified as NA Gonna sayomics glebratis,
Speaker 4: okay uh. And I think that's also part of why
Speaker 4: they're saying call everything non albacans because it's like they've
Speaker 4: been renaming some things, which is important but also gets confusing.
Speaker 3: Yeah.
Speaker 2: Yeah.
Speaker 4: And then also Canada parasilosis, so that's the other one, sure,
Speaker 4: And all of three of them do tend to have
Speaker 4: more resistance to antifungals than Canada albacans. And so we'll
Speaker 4: talk a little bit more about them a little bit,
Speaker 4: and you can ask questions and I might have the answers.
Speaker 4: But for most of this episode, especially for the like
Speaker 4: pathogenicity part of things, I'm going to focus on Canada albacans.
Speaker 4: It is by far the most common, something like ninety
Speaker 4: percent of us are colonized right now as we speak,
Speaker 4: on our skin, or in our mouths, or in our
Speaker 4: vaginas or in our guts because it can live there too.
Speaker 4: So Canada is or causes what we often call an
Speaker 4: opportunistic infection, meaning that when the opportunity arises, it will
Speaker 4: cause infection, and when it does not arise, it simply
Speaker 4: coexists with.
Speaker 3: Us and maybe even beneficial.
Speaker 4: Maybe though I didn't research that at all. It's okay,
Speaker 4: I have a paper love it, and it lives not
Speaker 4: just on our skin and in our mucous membranes, but
Speaker 4: also in the environment, and mostly just hangs out there
Speaker 4: a little bit unobtrusive until it becomes a problem. I
Speaker 4: think of it as just getting too big for its
Speaker 4: breeches and deciding to take over the place, writing executive orders,
Speaker 4: and all of the judges and other lawmakers are nowhere
Speaker 4: to be found, can't keep it in check.
Speaker 3: Just kidding, I guess this is fine for me to
Speaker 3: take over. No one's here, like.
Speaker 4: Yeah, no one else is here, I'll just move in.
Speaker 3: Yeah.
Speaker 4: So let's talk about what kinds of problems it can cause,
Speaker 4: because it's really varied, and not all Canada infections are
Speaker 4: created equal. There are broadly two big categories of candidal infections.
Speaker 4: There's muco cutaneous infections, so skin and mucus membranes, and
Speaker 4: then there are systemic infections. You can probably guess which
Speaker 4: one is more severe the most I don't even know
Speaker 4: if this is I don't know if it's true to
Speaker 4: say the most common, but probably like the thing that
Speaker 4: certainly I think about in that most people probably think
Speaker 4: about with Canada is a vaginal infection or volvovaginal candidiasis.
Speaker 4: And we kind of said this already, but something like,
Speaker 4: seventy five percent of people with a vagina will have
Speaker 4: candidiasis at least once in our lives. Six to ten
Speaker 4: percent of us may have recurrent volvovaginal candidiasis, which is
Speaker 4: usually defined in the literature as more than four per year,
Speaker 4: with resolution of the symptoms in between each episode.
Speaker 3: Okay, not just like persistent, Like so, I mean, okay,
Speaker 3: that is the chronic part. Are there? How long?
Speaker 2: Oh?
Speaker 3: Okay? Never mind? Am I getting ahead of things already?
Speaker 7: Yeah?
Speaker 4: You're asking a lot.
Speaker 3: Of questions like how long does the east infection last?
Speaker 3: How long does treatment? How long does it take to
Speaker 3: resolve things? How long does it? Yeah, does it ever
Speaker 3: self resolve?
Speaker 4: Yeah, certainly can certainly can self resolve. How long it
Speaker 4: lasts just totally depends on the person and their immune
Speaker 4: system and what kind of treatment they get, if they
Speaker 4: get treatment. Treatment depends on the situation. It can be topical,
Speaker 4: so sometimes we use like vaginal suppositories or vaginal creams,
Speaker 4: or it can be oral and that's usually a shorter
Speaker 4: course unless it's a more resistant strain or you have
Speaker 4: recurrence or something like that.
Speaker 3: Then sometimes you need a.
Speaker 4: Prolonged course of oral antifungals.
Speaker 3: Okay, what real quick one question? Okay, So, for the
Speaker 3: people who have recurrent yeast infections, what is driving that recurrence?
Speaker 3: Isn't that a great question? We don't know. We don't know.
Speaker 4: Okay, Yeah. What I can tell you a little bit about,
Speaker 4: since I haven't even mentioned it yet, is what the
Speaker 4: symptoms of a vaginal uast infection are.
Speaker 3: Sorry, I just got excited.
Speaker 4: I love it, Aaron, don't ever apologize for your excitement.
Speaker 4: But again, most of us is probably other things. Yes,
Speaker 4: most of us have probably experienced this. We can see inflammation,
Speaker 4: we see a white, chunky, cheesy kind of cottage cheese discharge, itching,
Speaker 4: burning pain. And this is an infection that is very
Speaker 4: easy for people to and by people I mean the
Speaker 4: people not experiencing it. But it has a substantial economic
Speaker 4: and morbidity burden. And we'll talk a little bit more
Speaker 4: about that later on in this episode. The risk factors
Speaker 4: for like why do people get YaST infections and some
Speaker 4: people don't? Or when does someone get a east infection?
Speaker 4: Risk factors can include poorly controlled diabetes. Sometimes we see
Speaker 4: associations with sexual activity, but it's not considered by any
Speaker 4: means of sexually transmitted infection because again this is like
Speaker 4: a commensal We also can see an increase in cases
Speaker 4: with increased estrogen states, so like during pregnancy and things,
Speaker 4: But by far the most common is antibiotic use. Yeah,
Speaker 4: and that's true for a lot of candidal infections, not
Speaker 4: just global vaginal infactions, right, But it's not just the vagina.
Speaker 4: Our other mucous membranes can often get infected. So we
Speaker 4: can see oral or esophageal candidiasis, which at least east
Speaker 4: in the US we often call thrush, and I think
Speaker 4: that they call thrush like a variety of candidle infections
Speaker 4: in other countries too. But that is when you get
Speaker 4: infection of the tongue, the oral mucosa, the gingabus, or
Speaker 4: your gums or your throat or esophagus, and you usually
Speaker 4: will see this kind of off white yellowish. It can
Speaker 4: almost be like almost so dark that it looks kind
Speaker 4: of brownish or blackish, just depending on like how long
Speaker 4: it's been there in things. But this plaque that forms
Speaker 4: in the mouth or in the throat, most of the
Speaker 4: time with these infections, we see them with some type
Speaker 4: of immunal compromising condition, so something like HIV, AIDS or
Speaker 4: chronic steroid use, including yes, inhaled corticosteroids if you're not
Speaker 4: rinsing your mouth, and that's why you're supposed to rinse
Speaker 4: your mouth after you use like a inhaler.
Speaker 3: That's interesting, okay, okay.
Speaker 4: Or conditions that cause like a reduction in saliva, which
Speaker 4: is going to help to wash out the yeast that's
Speaker 4: in your mouth and keep it moving.
Speaker 3: What would that what reduces sali?
Speaker 4: Oh, something like chogrin syndrome, which is quite rare. But
Speaker 4: then there's other things that I don't know, other specific
Speaker 4: conditions where people might have less saliva, or people who
Speaker 4: wear dentures I think too, are at higher risk of
Speaker 4: oral candidiasis. Okay, But we can also see it on
Speaker 4: our skin or in our nails. We can get intertrigo,
Speaker 4: so like in the skin folds maybe say axila growin
Speaker 4: diaper rash for babies. You can get it on the penis,
Speaker 4: we call that balinitis. You can also get it on
Speaker 4: the nails, so either with like an ingrown nail, so
Speaker 4: we call that paranikea or onycomycosis, which is like the
Speaker 4: nail infection.
Speaker 3: Is that like on top of your nail or under
Speaker 3: your nail or like, how does that happen?
Speaker 4: It's like within the nail itself, rail itself. Yeah yeah, okay, yeah,
Speaker 4: it's here, it's there, it's everywhere. So given the right
Speaker 4: set of circumstances, it can absolutely flourish, and sometimes it
Speaker 4: can really go too far and cause a systemic or
Speaker 4: invasive infection inside of our box. The most common and
Speaker 4: most serious of these invasive candidal infections is called candidemia,
Speaker 4: which is a bloodstream infection, so yeast growing in our bloodstream,
Speaker 4: and this has a mortality rate of thirty to forty percent,
Speaker 4: depending on how you calculate it. And that's today, and
Speaker 4: that's in high income countries.
Speaker 3: And that's with all the treatments available.
Speaker 4: Exactly yep, yeah wow. And part of that is because
Speaker 4: of just how hard it is to diagnose and treat
Speaker 4: these infections, especially once they've gotten into our bloodstream, but
Speaker 4: also because the vast majority of people who end up
Speaker 4: with a bloodstream infection are very stick to begin with.
Speaker 4: So we see this really commonly in things like icee use,
Speaker 4: when people are already you know, their immune systems are
Speaker 4: kind of at their limit and things like that. Once
Speaker 4: someone has an invasive candidal infection. They can end up
Speaker 4: with a number of other places that this candida in
Speaker 4: effects thereafter. So you can get an infection in the
Speaker 4: eye and it can cause candida end ophthalmitis, which can
Speaker 4: potentially cause permanent blindness. It can go into the heart
Speaker 4: and cause endocarditis, so infection of the heart and.
Speaker 3: The valves of the heart.
Speaker 4: Okay, it can get into the central nervous system, and
Speaker 4: we see this commonly in premature newborns something like fifteen
Speaker 4: to twenty percent of the time if a premi ends
Speaker 4: up with invasive candidiasis, it will end up in their
Speaker 4: central nervous system, so with ameninditis or and encephalitis, I know.
Speaker 4: And then especially after surgeries or other like abdominal procedures,
Speaker 4: people can get abdominal candidiasis and that can result in
Speaker 4: like a fungal abscess or can sometimes infect the liver
Speaker 4: or the spleen and in those cases can sometimes cause
Speaker 4: a really prolonged infection that's really hard to treat.
Speaker 3: Do we have a more granular answer as to how
Speaker 3: this happens. Then there's a breakdown immunosuppression and things just
Speaker 3: sort of bill over. It's a good question, not not
Speaker 3: a super more.
Speaker 4: Granular one than that. Okay, there's always, I mean almost always,
Speaker 4: there's going to be some I say almost just a hedge.
Speaker 4: But realistically there's always going to be some kind of
Speaker 4: like precipitating events, right, whether it's some other infection, whether
Speaker 4: it's you know, a bone marrow transplant, a solid organ transplant,
Speaker 4: you're on immunosuppressive drugs, you have, you know, HIV AIDS,
Speaker 4: like you're born with an immunodeficiency. So many potential conditions
Speaker 4: that lead someone to be more susceptible, and then it's
Speaker 4: like those right set of circumstances. The other thing that's
Speaker 4: very commonly predisposed of someone to an invasive infection, especially
Speaker 4: a bloodstream infection, would be having indwelling lines. So if
Speaker 4: you have ports, if you have catheters, as we'll see,
Speaker 4: Canada forms biofilms very easily, and so they can colonize
Speaker 4: and form a biofilm on those indwelling lines and then
Speaker 4: put you at risk for invasive infection because it's just
Speaker 4: bopping off little Yeasti's from the bio film.
Speaker 3: I feel like. So on this podcast, we have talked
Speaker 3: about a few other opportunistic pathogens that tend to just
Speaker 3: hang out and then crop up when something is a
Speaker 3: little bit out of balance, there's dysbiosis whatever. And I
Speaker 3: do we know why Canada rather than staph oreus? Or
Speaker 3: why Canada rather than strap? You know, like, what is
Speaker 3: that deciding factor?
Speaker 4: I don't, Well, I don't think it's always an either
Speaker 4: or sure of course not yeah, but yeah, I don't.
Speaker 3: I don't know.
Speaker 4: It's a good question, I mean, and it could be
Speaker 4: any of those. So it might just depend on that individual.
Speaker 4: What is their skin more colonized with, what do they
Speaker 4: happen to have on their bodies, what other antibiotics are
Speaker 4: they being exposed to, what happens to gain that foothold
Speaker 4: to begin with, or what other you know, Because our
Speaker 4: immune systems respond to bacteria and to fungi in different ways.
Speaker 4: So what type of immunal compromising condition do you have?
Speaker 4: And does it leave you more susceptible to fungus because
Speaker 4: your immune system is just not as good at getting
Speaker 4: at that fungus versus a bacteria or something like that.
Speaker 4: Are you already on all the antibiotics possible and so
Speaker 4: you've killed all those and now only the yeast are left.
Speaker 7: Yeah.
Speaker 3: Yeah, and as a.
Speaker 4: Fungus, Canada is already in some ways kind of harder
Speaker 4: for us to fight off compared to some bacteria because
Speaker 4: it's a eukaryote rat, right, so it's a little bit
Speaker 4: closer to us, So it's harder for us to have
Speaker 4: anti fungals. It's harder for our body to recognize it sometimes. However,
Speaker 4: Canada is also special and has quite a number of
Speaker 4: virulence factors that facilitate its ability to infect us and
Speaker 4: cause disease. For one thing, it can do that switching
Speaker 4: thing that I mentioned at the top. It can exist
Speaker 4: as a yeast or as this filamentous hyphie form depending
Speaker 4: on its environment, and this allows it to disseminate widely
Speaker 4: when it's a yeast, right, it's really hardy. It can
Speaker 4: exist in the environment, it can beat bop but between people,
Speaker 4: and then it allows it to invade through our epithelial
Speaker 4: barriers when it's in its highfel form, and then that
Speaker 4: also allows it to evade a lot of our immune responses.
Speaker 3: Okay, so the highful form does impact our immune like
Speaker 3: its munogenicity or something.
Speaker 4: Detection majorly majorly, And so it's really the highful form
Speaker 4: that we tend to see that ends up being the
Speaker 4: reason that we have invasive disease.
Speaker 3: And so are all canada albukens, individual you know, cells
Speaker 3: or whatever capable of this transformation.
Speaker 4: As far as I know, yes, And there are differences,
Speaker 4: and it does seem like the switching part of it
Speaker 4: is what makes them so good at causing disease, because
Speaker 4: when you breed strains that are only highful or only yeast,
Speaker 4: they're not quite as good. But in general they all
Speaker 4: can do both. They're quite adept like that. Canada also
Speaker 4: has a bunch of proteins that we call adhesions, which
Speaker 4: I feel like we've talked about this who knows on
Speaker 4: what episode, But they're basically sticky protein that allow it
Speaker 4: to make these biofilms and to colonize places like our
Speaker 4: skin and mucus membranes and also things like catheters, pick lines,
Speaker 4: like all of these lines that, especially if someone is
Speaker 4: already ill and in the ICU, they usually have quite
Speaker 4: a lot of lines and a biofilm. For anyone who's
Speaker 4: forgotten the glory that is biofilms, they're these really complex
Speaker 4: assortments of a bunch of different microorganisms that end up
Speaker 4: forming their own protective barrier, this little extracellular matrix that
Speaker 4: completely blocks our immune response from accessing them, which means
Speaker 4: that they can continue butting off these little yeasti's or
Speaker 4: having their little filamentous forms just kind of creep out
Speaker 4: and go invade deeper into our bloodstream. For example, where did.
Speaker 3: We was it Legionnaire's disease? Where we talked a lot
Speaker 3: about it.
Speaker 4: Definitely talked about them yeares. But something since then too,
Speaker 4: because that was a long time ago by camera. Yeah,
Speaker 4: I can't remember what it was someone else, do you remember?
Speaker 4: I have a better memory than us. But lastly, they
Speaker 4: also have a bunch of enzymes that they can secrete
Speaker 4: these this fungus to help break down our endothelial cell
Speaker 4: barriers and damage our cells and hide from our immune system.
Speaker 4: And what's so fascinating is that part of the way
Speaker 4: that Canada does this is actually by recognizing some of
Speaker 4: our metabolic cues. So they're sensing what's going on in
Speaker 4: their environment, aka in our bodies, and changing the way
Speaker 4: that they grow, changing the structure of their own cell wall.
Speaker 4: They are just really really well adapted to our human bodies.
Speaker 4: And probably the two biggest challenges when it comes to
Speaker 4: dealing with candidal infections, especially the severe ones, but even
Speaker 4: you know, mucocutaneous infections, which I'm not saying those are
Speaker 4: not severe, just in comparison to bloodstream infections. It's diagnosis
Speaker 4: and treatment, and the diagnosis of Canada is really challenging
Speaker 4: in part because the gold standard is to grow it
Speaker 4: in culture, and these grow really slowly. They take a
Speaker 4: really long time to grow in culture, and our culture
Speaker 4: methods are imperfect. So if you have, say a low abundance,
Speaker 4: you might get negative cultures even though you have plenty
Speaker 4: of yust growing in your body.
Speaker 3: Well, and then how do we because it's a commensal
Speaker 3: and it's on you said ninety over ninety percent of people,
Speaker 3: how do we know whether detection of Canada is a
Speaker 3: problem or like regular growth or overgrowth? Great question.
Speaker 4: So, yeah, you can have false positives and false negatives,
Speaker 4: both directions, right, depending on exactly what site you took
Speaker 4: it from, depending on how you took the samples. In general, though,
Speaker 4: it does not belong in our blood. So if Canadas
Speaker 4: are growing for doing blood sample, of course, yeah, but
Speaker 4: you're right if it's from like a skin sample, is
Speaker 4: it overgrowth or is it not? And some of that
Speaker 4: comes down to like clinical diagnosis as well too, what
Speaker 4: do things look like and stuff like.
Speaker 3: That, are your symptoms? Are you expecting some discomfort?
Speaker 6: Yeah?
Speaker 4: Exactly, exactly. There are PCR methods and things, but they're
Speaker 4: not always available. And then treatment is hard in part
Speaker 4: because of the toxicity of a lot of drugs that
Speaker 4: we use and because of increasing anti fungal resistance.
Speaker 3: Yeah, yeah, yep.
Speaker 4: That's it. I could talk a little bit more about
Speaker 4: the details of the treatment, but it's it's a little
Speaker 4: bit boring and niche.
Speaker 3: So well, maybe there are times when I talk about
Speaker 3: treatment in the history, and so maybe then we can
Speaker 3: if they.
Speaker 4: Have questions, Yeah, there are gaps, So tell me hearing
Speaker 4: about the history of this little fun guess, won't you?
Speaker 3: I will? I will. Modern society.
Speaker 4: As simple. I love when episodes start like this, Aaron,
Speaker 4: I just love it. Keep going.
Speaker 3: Honestly. Sometimes I write this and then I read it
Speaker 3: over and I'm like, why did you write this? And
Speaker 3: it's too late. Now here we are.
Speaker 4: Yes, it's great, That's why I keep going.
Speaker 3: Modern society is blamed for a whole host of diseases
Speaker 3: and disorders, depression and other mental health disorders, certain kinds
Speaker 3: of cardiovascular disease, metabolic dysfunctions, even allergies and asthma. To
Speaker 3: some extent, this is not a novel concept. The Industrial
Speaker 3: Revolution in the nineteenth century sparked intense discussion over how
Speaker 3: things like long working hours and stress, poor nutrition, lack
Speaker 3: of sunshine, and education for women contributed to the rise
Speaker 3: in you know, these nervous disorders like neurasthenia or hysteria.
Speaker 3: Setting aside the problems with some of those diagnoses, especially
Speaker 3: neurasthenia and hysteria, and whether their relationship with with modernity
Speaker 3: can truly be discs as causal, I think that this
Speaker 3: idea of diseases of modernity captures a reality that we
Speaker 3: sometimes struggle with, and that is that progress comes at
Speaker 3: a cost. Most of the costs that people are concerned
Speaker 3: with are general or hard to quantify. It just as
Speaker 3: like a feeling that we have. So for example, our
Speaker 3: computers are capable of more than we could have dreamed of,
Speaker 3: and at the same time we are more sedentary and
Speaker 3: overconnected than we have been in you know, most of
Speaker 3: human history, contributing to chronic and mental health conditions. Have
Speaker 3: things improved overall thanks to computers, our computers and net
Speaker 3: positive absolutely, like, there's no doubt about that. But we
Speaker 3: can also consider the cost factored into that equation hundred percent. Yeah,
Speaker 3: And I think that we are especially prone to thinking
Speaker 3: that science and medicine moves in one direction, more knowledge,
Speaker 3: more treatments and cures, better health care when it's not
Speaker 3: being thwarted by uninformed disinformation spreadish like RFK Junior and
Speaker 3: his ilk. But unfortunately, this forward progress, it's not always
Speaker 3: the case, or at least there's a more nuanced story
Speaker 3: to tell. Sometimes it's more of like a two steps forward,
Speaker 3: one step back kind of a thing, and rarely are
Speaker 3: we able to predict what that backward step might look like.
Speaker 3: This was certainly the case with antibiotics. And no, I'm
Speaker 3: not talking about antibiotic resistance. I mean people did that
Speaker 3: is a step back, and people did see the writing
Speaker 3: on the wall almost immediately when they came out. But
Speaker 3: I mean Canada, Oh my gosh, I love this. Yeah.
Speaker 3: When penicillin came onto the scene in the nineteen forties,
Speaker 3: quickly followed by other antibiotics such as streptomycen in the
Speaker 3: nineteen fifties. They led to a revolution in healthcare. It's
Speaker 3: a powerful story that we all know well, and if
Speaker 3: you don't, you should check out our antibiotics episodes from
Speaker 3: years back. But the miraculous recovery of patients on the
Speaker 3: verge of death from a bacteria infection, that's just one
Speaker 3: of the transformations brought about by the advent of these drugs.
Speaker 3: The other was Canada changed from a mostly benign which
Speaker 3: is not to say it wasn't uncomfortable or caused issues
Speaker 3: superficial fungal infection to a sometimes invasive systemic disease, and
Speaker 3: ultimately it led to a few fringe doctors promoting an
Speaker 3: unsupported hypothesis that to this day is used to sell
Speaker 3: people's snake oil supplements that can harm much more than
Speaker 3: they can heal. Oh, I'm so shocked to hear that.
Speaker 3: I got so like, just frustrated with this episode anyway,
Speaker 3: and that part. But before we can tell the story
Speaker 3: of that transformation, let's first go back in time to
Speaker 3: the early history of candidiasis. Okay, of course it's Hippocrates,
Speaker 3: like it's always hypocritsial.
Speaker 4: I'm gonna say I was going to get a little
Speaker 4: sad if there wasn't, because I was like, gosh, is
Speaker 4: this only going to be a modern thing, But like, no,
Speaker 4: it must have been around forever.
Speaker 3: It's been around for It's been around forever forever.
Speaker 4: Yeah, yeah, it's our friend. It lives with us.
Speaker 3: Yeah, yeah, yeah. Sometimes it's like, you know, a little
Speaker 3: not even codependent, but just like dependent, and we're like
Speaker 3: we little stop.
Speaker 4: Like yeah, stop calling me, Stop calling it's too much.
Speaker 3: Do not disturb mode, just like yeah, okay. Hippocrates, in
Speaker 3: one of his classic texts, he describes thrush like oral
Speaker 3: thrush is what I'm referring to, particularly in people who
Speaker 3: are already sick or in poor health. Galen also made
Speaker 3: mention of thrush, especially in sick kids. And there's a
Speaker 3: smattering of mentions throughout the sixteen hundreds and seventeen hundreds
Speaker 3: where thrush, thrush really is what predominates throughout history. And
Speaker 3: that's understandable because yeah, yeah.
Speaker 4: Because it would have been there, and no one was
Speaker 4: going to talk about vaginas of.
Speaker 3: Course, not yeah, no, no, but it was. Actually thrush
Speaker 3: was recognized as relatively common in newborns, and apparently so
Speaker 3: common in France that in seventeen eighty six, a medical
Speaker 3: society offered a reward for its study. Oh interesting, Yeah,
Speaker 3: outbreaks of thrush were known to happen at lying in
Speaker 3: hospitals where people came to give birth and then spend
Speaker 3: some time in recovery afterwards, and so there would be
Speaker 3: like outbreaks throughout the hospital. And in the eighteen hundreds
Speaker 3: is when the many faces of candidiasis or Canada began
Speaker 3: to be noted esophageal vaginal. So the first vaginal yeast
Speaker 3: infection was clinically described in eighteen forty nine. It's so
Speaker 3: late and published in the Lancet. Yeah wow, Okay, mouth lesions,
Speaker 3: brain lesions, even intestinal disease, even some systemic infections. But
Speaker 3: disentangling what caused these infections was much more challenging, especially
Speaker 3: when this yeast can overgrow or cause infections on so
Speaker 3: many different parts on the body, in the body, everywhere,
Speaker 3: or when they are like moral or ethical considerations, like
Speaker 3: doctors were reluctant to examine women, and even when a
Speaker 3: doctor did conduct an exam and found a yeast infection,
Speaker 3: they were like, oh, it's just a symptom of another disease.
Speaker 3: It's not a condition. In its own, right. Yeah, that's
Speaker 3: so interesting, okay. I mean, but similarly oral thrush. You know,
Speaker 3: you talked about how it can almost be like brown.
Speaker 3: It was recognized or thought to be the precursor to
Speaker 3: diphtheria in a lot of cases because that thick membrane
Speaker 3: as well. Yeah, okay, And in some cases the infectious
Speaker 3: nature of these lesions was suspected or like couldn't really
Speaker 3: be ignored. It was like, well, it has to be infectious,
Speaker 3: and in other times it was. The infectious nature was
Speaker 3: proven by experimental infections, one of which at least one
Speaker 3: of which led to an infant's death. Healthy infant. Let's
Speaker 3: just infect a bunch of these with this and see
Speaker 3: what happens. And one died some of that absolutely horrific,
Speaker 3: that's horrible.
Speaker 4: Yeah, this was in the eighteen hundred, eighteen hundreds.
Speaker 7: Yeah, oh god, yep.
Speaker 3: And you know, I think that around this time when
Speaker 3: germ theory rose to prominence, it reinforced this idea of
Speaker 3: one microbe, one disease, one cause, one disease, kind of
Speaker 3: a thing where one pathogen was responsible for one infection
Speaker 3: in particular, which is great for diagnosis and developing treatments.
Speaker 3: Or vaccines, but at the same time it made it
Speaker 3: harder for people to realize or recognize when something didn't
Speaker 3: fit that paradigm, such as Canada, which by this time,
Speaker 3: let's say, by the early nineteen hundreds, went by a
Speaker 3: million different names. And so for the full picture of
Speaker 3: what Canada was capable of, we needed someone who was
Speaker 3: able to look past the trees to see the entire forest.
Speaker 3: And that someone turned out to be Rhoda Benham, who
Speaker 3: later became a leader in the emerging field of medical mycology.
Speaker 3: In a nineteen thirty one article in the Journal of
Speaker 3: Infectious Diseases, she put forth the idea that all of
Speaker 3: these diverse infections from mouth to vaginal to intestina, all
Speaker 3: of these different things, each of which had been attributed
Speaker 3: to different fungal species with like different names, because they
Speaker 3: were like, oh, we isolated this from the mouth, Oh
Speaker 3: this came from the fingernail, right, it must be this
Speaker 3: different thing. It actually just came from one species one organism,
Speaker 3: which at the time was Manilia alba cans later turned
Speaker 3: into Canada alba cans, which also did you know means
Speaker 3: whitening white, Like it's like.
Speaker 4: I did not white white, white, white, white, does tend
Speaker 4: to have white cheesy business.
Speaker 3: Yeah, exactly, she wrote. Quote. If one were ignorant of
Speaker 3: the source of these cultures, one would be unable to distinguish,
Speaker 3: for example, m alba cans isolated from thrush, from m
Speaker 3: silosis isolated from sprue, and it would seem necessary for
Speaker 3: the present to regard such forms as merely strains of
Speaker 3: one species.
Speaker 2: End quote.
Speaker 4: There you go in other words, like just look at it.
Speaker 4: They're all the same.
Speaker 3: It's all the same. Stop calling these things different names.
Speaker 3: It's the same thing, same thing, the same thing, which
Speaker 3: was a pretty like novel idea, I think, for like,
Speaker 3: the concept that this thing could be cause infections in
Speaker 3: such diverse basically everywhere in the body. It seemed like
Speaker 3: it's a new idea. And so at this point, let's
Speaker 3: say the nineteen thirties or so, Canada had caught the
Speaker 3: interest of a few researchers, but to be honest, it
Speaker 3: was more of an afterthought, like not super pressing. It
Speaker 3: was like there were a lot of other things that
Speaker 3: people were concerned with at the time. Wasn't the hottest thing,
Speaker 3: but the birth of the antibiotic era was about to
Speaker 3: change all that by the nineteen fifties, antibiotics had saved
Speaker 3: countless lives around the world. But the excitement that had
Speaker 3: accompanied the emergence of this new class of drugs was
Speaker 3: beginning to be tempered by a few unexpected consequences. New
Speaker 3: antibiotic resistance strains causing infections that couldn't be treated, allergic reactions,
Speaker 3: toxic side effects in some of these, and arise in Canada,
Speaker 3: infections both superficial and invasive in those receiving antibiotics. And
Speaker 3: this last observation led the Council on Pharmacy and Chemistry
Speaker 3: of the American Medical Association to release a statement in
Speaker 3: June of nineteen fifty one that said that bottles of
Speaker 3: the three leading antibiotics should carry the following warning quote
Speaker 3: Patients receiving these drugs may be more susceptible to manillial
Speaker 3: or other yeast like organisms. End quote.
Speaker 4: Wow, yeah, way back.
Speaker 3: When, way back when. And it's interesting this was not
Speaker 3: without controversy, right, because first of all, it was hard,
Speaker 3: I think for people to draw the connection between how
Speaker 3: were how exact actually were antibiotics causing this greater susceptibility.
Speaker 3: And secondly, since Canada is a commensal of humans, how
Speaker 3: do you distinguish between what is a harmless or a
Speaker 3: harmful overgrowth? And thirdly, what are we supposed to do
Speaker 3: about it?
Speaker 6: Right?
Speaker 3: Right at that time the nineteen fifty one no treatment,
Speaker 3: But within a few years that last question what do
Speaker 3: we do about it? Would be answered nineteen fifty four
Speaker 3: with the first anti fungal on the market, nic statin,
Speaker 3: which is the market name micostatin. This is developed by
Speaker 3: Elizabeth Hazen and Rachel Brown. A few years before I
Speaker 3: think it was like in production, and then by nineteen
Speaker 3: fifty four it was on the market. Most of the
Speaker 3: antibiotics then available were derived from fungal species, like penicillin,
Speaker 3: which had used these compounds to compete with bacteria like
Speaker 3: I feel like yeah, it's I just love yeah, and
Speaker 3: so using that same logic, Nystatin was developed from a
Speaker 3: bacterium Streptomyces norsea found in so oil from a friend's garden,
Speaker 3: like one of their friend's garden, and because Hazen and
Speaker 3: Brown reasoned that soil was this battleground for all sorts
Speaker 3: of microbes that are all like, let's bring out the
Speaker 3: big guns. You know what we're gonna here's this compound
Speaker 3: for this and this compound for that, and I'm going
Speaker 3: to outcompete you and I'm going to just destroy you.
Speaker 4: You got to think ecologically. I love it.
Speaker 3: Ecology matters, and so that's yeah, voila, there you go,
Speaker 3: nice Seaton. And then but the other two questions, sort
Speaker 3: of like when is Canada a problem and what why
Speaker 3: is it doing this? Those proved a little bit more
Speaker 3: challenging to answer. Clinical evidence was mounting that while antibiotics
Speaker 3: were associated with systemic and deadly infections with Canada through
Speaker 3: disrupting the microbiome, these weren't as common as initially thought,
Speaker 3: and it might actually have been a company nation of
Speaker 3: our detection methods improving for this, and so that being
Speaker 3: partially responsible for the apparent rise both in systemic as
Speaker 3: well as superficial and by superficial I mean like on
Speaker 3: your schedule exactly infections. But the important lesson was that
Speaker 3: antibiotics could disrupt someone's microbiome, which provided Canada an opportunity
Speaker 3: to grow more than it ordinarily would, and that disruption
Speaker 3: could happen from other things besides antibiotics, like for most people,
Speaker 3: any yeast infection would be handled relatively simply through an
Speaker 3: antifungal like nystatin, and then some of the later ones
Speaker 3: that came onto the scene. But for some, such as
Speaker 3: those who are immunocompromised, that microbial dysbiosis, regardless of whether
Speaker 3: it was triggered by antibiotics or not, could result in
Speaker 3: more invasive and difficult to treat infections, and Canada ended
Speaker 3: up around this time, let's say, the nineteen seventies and eighties,
Speaker 3: being labeled a quote unquote a disease of the diseased,
Speaker 3: which is like not maybe the nicest way to put
Speaker 3: it, it's not the best way to put it, but I
Speaker 3: think what it does is it conveys that this was
Speaker 3: an infection of disruption, something that would become even more
Speaker 3: clear in the nineteen seventies and eighties. In these decades
Speaker 3: with more patients than icee use, you know, as healthcare
Speaker 3: and our ability to help people improved, overall, we had
Speaker 3: more people who were you know, alive, can.
Speaker 4: Keep people alive even as they got sicker, and that
Speaker 4: comes with its own set of problems, complications.
Speaker 3: And then things like organ transplant. Also, you know, people
Speaker 3: who were on im you know, suppressive drugs to prevent rejection.
Speaker 3: Organ transplant was a very relatively, very new thing, not
Speaker 3: just relatively and so and then in especially in the
Speaker 3: nineteen eighties, the rise of the HIV AIDS pandemic and candidiasis.
Speaker 3: You touched on this a bit, but it was especially
Speaker 3: a problem for people with HIV AIDS, and one estimate
Speaker 3: suggested that by the mid nineteen eighties seventy five percent
Speaker 3: of people with AIDS had oral candidiasis, and that of
Speaker 3: course had the potential to become more invasive because their
Speaker 3: immune systems were so suppressed. And fortunately by that time
Speaker 3: there were newer anti fungal drugs that had come on
Speaker 3: the scene that were usually quite effective in treating these infections,
Speaker 3: and their development was in part motivated by the spread
Speaker 3: of this yeast. But the increase in awareness that Canada
Speaker 3: received during this time it also inspired a different movement,
Speaker 3: one not entirely grounded in scientific evidence. Okay, In nineteen
Speaker 3: eighty two and nineteen eighty three, two books came out
Speaker 3: claiming that Canada was the cause of a host of
Speaker 3: poorly understood and ill defined physical and mental health issues.
Speaker 3: One book was titled The Missing Diagnosis by or Orient
Speaker 3: Trusts and the other was The Yeast Connection, A Medical
Speaker 3: Breakthrough by William Crook literally good Namebor Crook. I can't
Speaker 3: believe it.
Speaker 4: I can't believe it. I mean, I guess you don't
Speaker 4: have control over that, but you don't.
Speaker 3: Yeah, it just as it just was funny to me. Yeah.
Speaker 3: And the overall premise of both of these books were
Speaker 3: that many people were unknowingly living with a chronic overgrowth
Speaker 3: of Canada, which led to an overall more suppressive state
Speaker 3: and predisposed them to a variety of conditions ranging from
Speaker 3: tissue injury and eucosal infections to mental health issues. A
Speaker 3: self diagnosis checklist was included along with a nine step
Speaker 3: program with also many substeps for treating this alleged overgrowth. Okay,
Speaker 3: diagnosis was confirmed only with a positive response from the
Speaker 3: nine step program.
Speaker 4: What were the nine steps?
Speaker 3: Were they like? Okay you that and.
Speaker 5: Exercise basic will make you feel better? Yes, exercise was
Speaker 5: one of them. A diet was another. Okay, here we go,
Speaker 5: I found it. Continuing observation in order that concomitant diseases
Speaker 5: can be detected, accurately diagnosed, and specifically treated. Exercise program,
Speaker 5: mental health program, avoidance of chemical pollutants, maybe there's more.
Speaker 3: Information in the book on that. The use of antioxidants, okay,
Speaker 3: use of special laboratory tests like the ratio of helper
Speaker 3: cells to suppress our cells, blood vitamin studies, mineral studies
Speaker 3: and hair blood and urine amino acid studies in urine
Speaker 3: essential fatty acid profile. That's step six, right, okay, okay,
Speaker 3: special dietary program. We'll get into that in a second,
Speaker 3: including supplements those.
Speaker 4: On here, of course, the use of to get from them, yep.
Speaker 3: The use of anti fungal agents for months topically and orally.
Speaker 3: The use of allergenic extracts of Canada albacans for immunotherapy
Speaker 3: or provocation neutralization. Okay, that's yeah, that is that's nine.
Speaker 6: Okay, yeah, okay, Aaron, So.
Speaker 4: So you do all these things at once, so you
Speaker 4: have no idea what's helping you.
Speaker 3: Do all these things at once? Right right? As far
Speaker 3: as I can tell, it's not a step wise thing. Okay, yeah, okay.
Speaker 3: So just to give you a better sense of like
Speaker 3: the picture of this, I'm going to quote from Trust's
Speaker 3: Missing Diagnosis quo. This is a this is just excerpted.
Speaker 3: There's a lot more where this comes from. Okay quote
Speaker 3: depression is common, often associated with difficulty in memory, reasoning,
Speaker 3: and concentration. These symptoms are especially severe in women, who,
Speaker 3: in addition, have great difficulty with the explosive irritability, crying,
Speaker 3: and loss of self confidence that are so characteristic of
Speaker 3: abnormal function of the ovarian hormones. Poor and organ response
Speaker 3: to these sex hormones is confirmed by the common association
Speaker 3: of acne impairment or total loss of libido, and the
Speaker 3: whole range of abnormalities of menstrual bleeding and cramps, as
Speaker 3: well as a very high incidence of endometriosis and those
Speaker 3: who have undergone hysterectomy. Many of these patients also start
Speaker 3: developing multiple intolerances to foods and chemicals, making it increasingly
Speaker 3: difficult for them to live in a normal environment. Many
Speaker 3: or all of these intolerances disappear as the yeast problem
Speaker 3: is brought under control end quote what yeah, okay, So yeah,
Speaker 3: bringing it under control, I went through the nine steps there.
Speaker 3: It's a lot of it's that long term, not just
Speaker 3: anti fungals though also antibacterials were prescribed like antibiotics.
Speaker 4: What yeah, okay, mm hmmm mm hmm okay.
Speaker 3: Canada extracts, that one for amminotherapy and this anti the
Speaker 3: anti Canada diet. So there's a lot to unpack here.
Speaker 3: So first there's the vague and diverse array of symptoms
Speaker 3: of what was termed candidiasis hypersensitivity syndrome, and then women
Speaker 3: being called out in particular because of something about like
Speaker 3: sex hormones. It was unclear to me from that what
Speaker 3: the connection.
Speaker 4: Of that meant. Yeah, and like why does that have
Speaker 4: anything to do with Canada.
Speaker 3: H birth control was also blamed, of.
Speaker 4: Course, birth control has been blamed pretty commonly. Yeah, realistically,
Speaker 4: even if you're on an estrogen containing birth control, you're
Speaker 4: probably having lower estrogen levels on average than you would
Speaker 4: if you were well, certainly if you were pregnant, but
Speaker 4: also then if you were like cycling, and so there
Speaker 4: isn't really a good association between There is a slight
Speaker 4: association between like menopausal hormone therapy and a slight increase
Speaker 4: in use infections, but even that is not like major.
Speaker 3: Right, And also we're talking about yeast infections, right, vaginal
Speaker 3: yeast infections whatever this is yeah, yeah, yeah, yeah, And
Speaker 3: I like the other symptoms are like when I said
Speaker 3: earlier that like these are really vague. In general, it's
Speaker 3: things like headache and malay, so things that people do
Speaker 3: experience right, probably regularly in association, in association with who
Speaker 3: knows what, many different things.
Speaker 4: I mean, it just definitely feels like this is something
Speaker 4: that's preying on people who haven't found an answer from
Speaker 4: somewhere else.
Speaker 3: Literally, that's what I have done here. Yeah, we'll get there,
Speaker 3: But I want to tell you about the diet too, because,
Speaker 3: like I think that this is still incredibly incredibly popular.
Speaker 3: So the diet requires strict adherents and is incredibly limiting.
Speaker 3: So there's no sugar at all, even fruit, Like you
Speaker 3: can't have fruit, oh my god, Okay, no pork, no gluten,
Speaker 3: no popcorn, coffee, nuts, mushrooms, truffles, no alcohol. Many grains
Speaker 3: are excluded, but fresh and organic meats and fish. But again,
Speaker 3: no pork are allowed. Why no pork? Something about pork. Allegedly,
Speaker 3: according to this, pork contains some sort of retroviruses that. Yeah, yeah,
Speaker 3: like that retroviral something.
Speaker 4: So I'm not like pro probate. I love bacon, but
Speaker 4: I know it's terrible for me, but like it's not
Speaker 4: causing Canada.
Speaker 3: It's not. It's not. And these books, though, and the
Speaker 3: idea that they promoted became wildly popular, like selling out
Speaker 3: book prints or whatever, and leading many people to seek
Speaker 3: months of systemic and topical antifungals from their doctor. They
Speaker 3: discontinued birth control, and they started to take a suite
Speaker 3: of supplements that were probably not great. Actually, there have
Speaker 3: been a few cases of people who either go on
Speaker 3: the diet or start taking these supplements that end up
Speaker 3: putting them in a hospital, or they're on these anti
Speaker 3: fungals for so long anyway, So this it got to
Speaker 3: a point, it got to be such a problem that
Speaker 3: by nineteen eighty six or in nineteen eighty six, the
Speaker 3: Executive Committee of the American academ of Allergy and Immunology
Speaker 3: released a statement listing their critique of the candidiasis hypersensitivity
Speaker 3: syndrome and all linked to this because it has like
Speaker 3: almost like a point by point reputation, And their ultimate
Speaker 3: conclusion was that quote on the basis of the evidence
Speaker 3: so far reviewed and until appropriate published evidence to the
Speaker 3: contrary is brought to its attention, the Practice Standards Committee
Speaker 3: recommends that the concept of the candidiasis hypersensitivity syndrome is unproven.
Speaker 4: End quote, I mean pretty straightforward.
Speaker 3: It didn't really do anything. Over the next decade, though,
Speaker 3: researchers like started to look into this with carefully designed
Speaker 3: clinical trials because they're like, if this is the thing,
Speaker 3: this is we have a path forward.
Speaker 4: Right, let's figure out. Let's figure it out. So we
Speaker 4: figured it out, treat it well.
Speaker 3: They tested the anti the anti Canada diet. They there
Speaker 3: was a test or a trial with prolonged treatment with
Speaker 3: nistatin and also looking screening for Canada throughout the body.
Speaker 3: No strong evidence emerged for the condition. And if you
Speaker 3: look at candida is a hypersensitivity syndrome on Google scholar,
Speaker 3: you will find a few papers from the eighties and
Speaker 3: early nineties, but anything that's more recent tends to come
Speaker 3: from things like the Canada Clinic or like the Canda
Speaker 3: whatever sort of Canada pro pro this idea.
Speaker 4: They're clearly like they have an air reviewed because they're
Speaker 4: trying to sell you.
Speaker 3: A supplement, supplement or something, yeah, a book. Yeah, but
Speaker 3: and in fact, because like one of the ideas that
Speaker 3: they promote is that okay, you need to like for
Speaker 3: and why the diet is there is that it cuts
Speaker 3: down Canada in your gut and there's actually a paper
Speaker 3: from twenty twenty two that suggests that Canada in your
Speaker 3: gut is a mutualistic, beneficial back to or a beneficial
Speaker 3: organism and it's a sign of it can be a
Speaker 3: sign of a healthy, healthy gut.
Speaker 4: I mean, you want your gut micro boom to be
Speaker 4: quite varied, Yes.
Speaker 3: You do, you do. But yeah, nevertheless this persisted. This
Speaker 3: idea of Canada overgrowth or Candadias is hypersensitivity syndrome. And
Speaker 3: you've got countless organizations, supplement companies and forums dedicated to
Speaker 3: spreading the word. And why it has remained so popular,
Speaker 3: I think comes down to two main things, and the
Speaker 3: first is that it is what you touched on. Medicine
Speaker 3: doesn't have all the answers, and people seeking help are
Speaker 3: sometimes dismissed or have their questions ignored and their concerns ignored.
Speaker 3: And I don't doubt that people who think they have
Speaker 3: this condition or are experiencing symptoms of Candidias's overgrowth or
Speaker 3: Canada overgrowth are probably experiencing uncomfortable, disruptive, or even debilitating symptoms.
Speaker 3: But so far no evidence points towards Canada as the culprit.
Speaker 3: Doesn't mean that someone isn't having headaches or digestive issues,
Speaker 3: but that it's probably not Canada. And the Canada diet
Speaker 3: probably helps because you're paying attention to what you're eating.
Speaker 3: You're you're cutting out a lot of things that probably
Speaker 3: don't make you feel great.
Speaker 6: Right, it would be great if we could all cut
Speaker 6: out sugar, yes, Dice, I mean, yeah, there are great
Speaker 6: if some at least tone it down a bit or
Speaker 6: like some elements, but like not.
Speaker 3: Yeah, it's yeah, I eat so much, so many blueberries,
Speaker 3: I know that about you. Yeah, it's one of my
Speaker 3: absolute favorites. I mean, that's why I love Costco just
Speaker 3: everything else, clam shells, Yeah, fistfuls of blueberries. But but
Speaker 3: again these just because you're receiving a benefit or feel
Speaker 3: better from the Canada diet doesn't mean that your Candada
Speaker 3: levels are changing. In fact, there have been studies that
Speaker 3: indicate that there is no change. And honestly, it would
Speaker 3: be great if if it were Canada. Wouldn't that be
Speaker 3: nice because there'd be Here's here's a straightforward answer. There's
Speaker 3: probably a straightforward fix. This is what we can do.
Speaker 3: People who are desperate for answers, desperate for relief, may
Speaker 3: find themselves looking outside of medicine for someone to tell
Speaker 3: them what's happening, which brings me to the second reason
Speaker 3: why I think this has remained so popular. It's because
Speaker 3: there are countless people who are happy more than willing
Speaker 3: to profit off of it. There was one I just
Speaker 3: I googled anti Candida supplements just to see what was
Speaker 3: out there, and it's like endless options, of course, and
Speaker 3: I just I am. I am so livid, Like livid
Speaker 3: isn't even the right word. I'm just so exhausted by
Speaker 3: the fact that this is a thing that is continuing
Speaker 3: to grow and grow and grow. There was one supplement
Speaker 3: business and I won't name the name of it, but
Speaker 3: it popped up as one of the companies that's selling
Speaker 3: these anti Canada supplements, and I looked up, Okay, what
Speaker 3: is their net worth? What is their income? What do
Speaker 3: they get every year? Tens of millions of dollars every
Speaker 3: year for medicine backed quote unquote absolutely not medicine fact
Speaker 3: cleanses that promise to restore gut health or make you
Speaker 3: free from Canada.
Speaker 4: Aaron, I mean, it all just makes me want to
Speaker 4: do in a whole nother supplements episode because there's still
Speaker 4: so much more there.
Speaker 3: It's even like when we did that what last year?
Speaker 3: Yeah was that last year? Already it's worse. It's worse.
Speaker 3: It's growing and growing and growing.
Speaker 4: They're also I've been been looking at this ATLI. There
Speaker 4: are so many because you said these A lot of
Speaker 4: these people who promoted this idea back in the eighties
Speaker 4: were physicians.
Speaker 3: Oh so is the person who has the supplement right.
Speaker 4: That is what is on the social media's right now,
Speaker 4: which I won't call out my name, but like almost
Speaker 4: every very prominent even physician, influencer or whatever, sells at
Speaker 4: least one supplement or has advertised for at least one
Speaker 4: supplement or whatever. And it just makes it like, ah,
Speaker 4: it makes it so so so hard because you just can't.
Speaker 4: And it's not like we said in our Supplements episode,
Speaker 4: it's not like supplements are evil. It's not like are
Speaker 4: all bad. It's just that they're completely unregulated and so
Speaker 4: many of them are profiting off of miss and disinformation.
Speaker 3: I mean yeah, in terms of the morality question, I
Speaker 3: feel like it is pretty immoral to manipulate people and
Speaker 3: you're into them to sell to make money, to make
Speaker 3: yourself richer.
Speaker 4: But I just meant, like, we do human supplements in
Speaker 4: medicine for things.
Speaker 3: Yes, and we're painting with a broad brush here, but
Speaker 3: I think that like when we're talking about someone who's
Speaker 3: taking a supplement to reduce their Canada levels, right, absolutely.
Speaker 4: There's no evidence, there's no evidence.
Speaker 3: Yes, it's all, it's all. Yeah, it's predatory, predatory garbage.
Speaker 3: So yes, And then I think the other issue with this. Sorry,
Speaker 3: I didn't really mean to get this like.
Speaker 4: I said about it, I got you into it, so.
Speaker 3: But there's you know, I was also looking up. I
Speaker 3: was just curious because especially yeast infections, I have heard
Speaker 3: so many different home remedies, and you've got people who
Speaker 3: are like put a clove of raw garlic cut in half,
Speaker 3: tie it around a string, just coat it in yogurt coat,
Speaker 3: just like shove a bunch of yogurt up your vagina.
Speaker 3: That'll get rid of it, a jade or whatever, you know.
Speaker 3: Like I'm sure that there's something on that website that
Speaker 3: we yeah, yeah, disapprove of. But all of these things,
Speaker 3: like they're misguided, and it is just it reveals so
Speaker 3: much of what is wrong with expertise medicine. People being
Speaker 3: missed by medicine. Yeah, and like our limited capacity to
Speaker 3: answer all these questions. Probiotics, do they work? Maybe may
Speaker 3: maybe not? Maybe that question we cannot answer right now.
Speaker 3: What is even in a probiotic right? Which bacteria matter
Speaker 3: in what quantities? Which don't matter? Each person is unique,
Speaker 3: their microbiome is unique. I mean we don't even have like,
Speaker 3: you know, thinking about this and like an actual puzzle
Speaker 3: and you know you always put the edge pieces together first,
Speaker 3: like we're still flipping over pieces, like we're not even close.
Speaker 4: So true, that's so true. We don't even know how
Speaker 4: many puzzle pieces we're dealing with.
Speaker 3: Absolutely not. Could it be a one thousand piece puzzle
Speaker 3: or like one hundred thousand.
Speaker 4: Yeah, that's so true.
Speaker 3: I think that. Yeah. I think that the fact that
Speaker 3: the anti candida diet and these alternative approaches to treating
Speaker 3: yeast infections, just as an example, as are as prominent
Speaker 3: as they are, I think speaks to the failure of
Speaker 3: medicine to adequately meet people's needs, the disgusting greed and
Speaker 3: lack of regulation that allows people to sell snake oil
Speaker 3: on the basis of fear and lies. And also I
Speaker 3: think it shows the very human tendency to want answers
Speaker 3: to want to take action, and Aaron, I, I'm sure
Speaker 3: that you know things have improved or maybe there's reason
Speaker 3: to hope good news on the horizon. Sorry to end
Speaker 3: this so depressing.
Speaker 4: Oh that's okay. I don't know that what I'm going
Speaker 4: to say is going to be any less depressing. But
Speaker 4: we can get into what the landscape of Canada is
Speaker 4: like today.
Speaker 7: Let's do it, okay.
Speaker 4: So when it comes to I'll start with invasive candidiosis
Speaker 4: because that's obviously the most severe forms of candadiasis. We're
Speaker 4: talking systemic infections. A Nature Reviews disease primers from twenty
Speaker 4: twenty four reported an estimated community wide incidence rate. So
Speaker 4: if you're just looking at general population, you might think
Speaker 4: it's not that bad. It's around four cases per one
Speaker 4: hundred thousand people in high income countries. Ah, not that bad.
Speaker 4: But you would be wrong if you thought of it
Speaker 4: that way, because this is not a disorder systemic invasive
Speaker 4: candidiasis that is particularly prevalent amongst the general population, but
Speaker 4: in hospitalized patients worldwide, we see about one hundred cases
Speaker 4: per one hundred thousand hospital admissions, and in the ICU
Speaker 4: and estimated five to seven cases per one thousand ICU
Speaker 4: admissions in newborn babies, especially premature newborn babies. We see
Speaker 4: twelve cases of invasive candidiasis per one hundred thousand births
Speaker 4: of premature babies in the US.
Speaker 3: Wow.
Speaker 4: So this is a disorder, a disease that for most
Speaker 4: people who are listening or walking around, like on your
Speaker 4: commute to work, if you're here hearing this, you might
Speaker 4: think it's not that common. But if you work in
Speaker 4: a hospital, if you're unlucky enough to end up stick
Speaker 4: in the ICU, this is a very serious and seriously
Speaker 4: common problem. And with the rise of other strains of
Speaker 4: Canada like Canada ORS, which was first found only in
Speaker 4: two thousand and nine, it's a very very new, newly
Speaker 4: identified pathogen. Yeah, this is a species that was first
Speaker 4: identified in Japan and since two thousand and nine has
Speaker 4: been found in more than thirty countries. It spreads really
Speaker 4: rapidly through hospital settings, and it really rapidly gains resistance.
Speaker 4: A lot of times, the different strains of c ORS
Speaker 4: have resistance to begin with, but then it picks up
Speaker 4: new resistance. So we see pan resistance, we see resistance
Speaker 4: in c oors some strains to almost all of the
Speaker 4: anti fungals that we use, and it's been in the
Speaker 4: US since at least twenty thirteen, and to the CDC
Speaker 4: in twenty twenty three, there were four five hundred and
Speaker 4: fourteen new clinical cases of c oorus in the US
Speaker 4: in twenty twenty three, and it's been increasing. Like when
Speaker 4: you look at the graphs on the CDC c Oris page,
Speaker 4: it is like whoopop, it's exponential growth right now.
Speaker 3: It is, yeah, scary because it gains a foothold I
Speaker 3: feel like in hospital settings so easily too, where it's
Speaker 3: just like you can't get rid of.
Speaker 4: It right right. And that's not the only species that
Speaker 4: is of increasing concern. Canada parasylosis is a whole species
Speaker 4: complex that is also found really commonly. It's not like
Speaker 4: a new infection per se. But we're seeing increases in
Speaker 4: fluconazol resistance, which is one of the main antifungals that
Speaker 4: we use, especially for like mucocutaneous infections and things like that.
Speaker 4: We also are seeing increasing rates of what is now
Speaker 4: called nacacomics Glebrotis, which used to be Canada Glebrota.
Speaker 3: What rolled right off your tongue. I'm impressed.
Speaker 4: I practiced so much like every time I wrote it,
Speaker 4: I practicing it out loud. But this we also are
Speaker 4: seeing both increasing in distribution. It's like the second most
Speaker 4: important species in the United States and in northwestern Europe.
Speaker 4: But infection tends to be more severe and it rapidly
Speaker 4: requires resistance, compared to Canada Albicans, which tends to It's
Speaker 4: not like that you can't have resistance, but it's just
Speaker 4: for whatever reason, not as good at acquiring resistance genes.
Speaker 4: So there's a lot of different species that are kind
Speaker 4: of of concern and that are on the rise. When
Speaker 4: it comes to volvovaginal candidiasis, which we talked about already
Speaker 4: affects seventy five percent of people with a vagina at
Speaker 4: least once, literally so many of us. But even recurrent
Speaker 4: volvovaginal canadiasis affects an estimated one hundred and thirty eight
Speaker 4: million people with a vagina every year worldwide, and it's
Speaker 4: on the rise and estimated to hit close to one
Speaker 4: hundred and sixty million by twenty thirty.
Speaker 8: Okay, a couple questions. You said, this is four to
Speaker 8: five times a year at least four recurrent infections a year.
Speaker 8: Some papers call it at least three years. Okay, recurrent
Speaker 8: infections a year, but most most of them are four.
Speaker 3: Okay. A quick question before we talk more about about
Speaker 3: vaginal uast infections. The other species that you mentioned of Canada,
Speaker 3: do they tend to colonize the same or like cause
Speaker 3: infections because Alba cans Is a commensal, but these don't
Speaker 3: seem to be commensals. They seem to be pathogenic or
Speaker 3: are they?
Speaker 2: Yeah?
Speaker 4: So with Canada orus, it's so new that I don't
Speaker 4: know that we know Okay, it like you know, it
Speaker 4: wasn't ever found before, so has it been you know,
Speaker 4: certainly it can colonize our skin. I think it's estimated
Speaker 4: that like ten percent of people, if you just like
Speaker 4: screen people coming into a hospital or something, that ten
Speaker 4: percent of pe people who are colonized will go on
Speaker 4: to develop an invasive infection. So it's not like it
Speaker 4: causes infection in all of them. And same thing with
Speaker 4: you know what is now not a ceomic's glebrodis and parapsylalosis.
Speaker 4: Why is that one harder than yeah, the other one
Speaker 4: is anything right? And there's also there's more too, right,
Speaker 4: Like there's other candidaal or what used to be Canada
Speaker 4: and are now you know, reclassified. So most of these
Speaker 4: can be found on some percentage of the human population
Speaker 4: just as commensals.
Speaker 3: But in terms of the infections that they will cause,
Speaker 3: it's the same sort of suite of in theory.
Speaker 4: In theory, yes they could, but because I think, because
Speaker 4: especially with c Orus, we are screening for it in
Speaker 4: we are seeing it more as an invasive infection. Okay,
Speaker 4: where because and what does this just come down to
Speaker 4: the fact that Canada Albucins is still the most prevalent.
Speaker 4: So if there's going to be an overgrowth, it's going
Speaker 4: to win out in most case. I don't know certainly
Speaker 4: what used to be Canada glbrata and is now not
Speaker 4: caasaomici glbratis. It causes quite a lot of vaginal east infections,
Speaker 4: and we see you know, parasilosis as well, So we
Speaker 4: see all of these, but still overwhelmingly Albacans is the
Speaker 4: most prevalent.
Speaker 3: So if recurrent east infections are on the rise, vaginal
Speaker 3: east infections are on the rise, are they caused by
Speaker 3: Albacans or is it one of these other species like
Speaker 3: how much when you have a east infection. It's not
Speaker 3: like they will necessarily culture or do they always?
Speaker 4: Not necessarily that's the problem. You don't necessarily have to
Speaker 4: culture to get the data on what species it is.
Speaker 4: Like where I work, we do PCRs and we can
Speaker 4: then strain type it and species type it.
Speaker 3: But you always do strain type and species type or
Speaker 3: that's what does happen.
Speaker 4: YEA, the PCR that at least where I work, and
Speaker 4: this is not everywhere, but where I work, I swab
Speaker 4: everyone if I'm worried, Yeah, try not to treat eirically.
Speaker 4: Lots of people will just get empiric treatment. And the
Speaker 4: PCR test that we do checks for multiple different strains,
Speaker 4: so it's able to and multiple different species, so it's
Speaker 4: able to tell us what that species is, which also
Speaker 4: will give us a hint as to whether it's more
Speaker 4: likely to be resistant. For example, if you're talking about
Speaker 4: an invasive infection in a hospital setting, yes you're going
Speaker 4: to be culturing that or you're going to be doing
Speaker 4: something to figure out exactly what species we're talking about.
Speaker 4: But for a lot of muco cutaneous infections, people might
Speaker 4: be treated just empirically, meaning just based on clinical exam,
Speaker 4: which I'll be honest, it's usually pretty obvious, but not always.
Speaker 4: And the reason I always swab is because a lot
Speaker 4: of times you've got BV and yeast overgrowth. Like it's
Speaker 4: not only just a one thing, but a lot of
Speaker 4: people will be treated empirically, either because they don't have
Speaker 4: access to something like PCR, or they can't afford it
Speaker 4: because it might be you know, cost prohibitive or a
Speaker 4: lot like what we would do where I worked during
Speaker 4: residency is put it under a microscope and look at
Speaker 4: it under the swab. You know, look at the swabuder
Speaker 4: the microscope and then you can see the hyphel growth,
Speaker 4: but I don't know what species that is, and so
Speaker 4: then you're at least knowing for sure that it's a
Speaker 4: yeast infection and not a yeast plus other things, but
Speaker 4: then you don't necessarily know what species it is. So
Speaker 4: it totally just depends where you are and what the
Speaker 4: healthcare infrastructure is like, and so we don't know to
Speaker 4: answer your question of is it just mostly still sea
Speaker 4: ambacants on the rise, but it's contributed by all of
Speaker 4: these other species as well, and by the increasing antifungal
Speaker 4: resistance that we see especially in these other species of Canada,
Speaker 4: which again are on the rises in a lot of cases.
Speaker 4: And so that is a very real and very scary
Speaker 4: aspect of Canada right now, is just the rise in
Speaker 4: antifungal resistance, especially when it comes to c Orius. Something
Speaker 4: like thirteen to thirty five percent of isolates are found
Speaker 4: to be resistant to essentially all the antifungals.
Speaker 3: That we have and we just detected this sixteen years ago.
Speaker 4: Correct.
Speaker 1: That is.
Speaker 3: Very scary. I know.
Speaker 4: There's a lot of need obviously for research in better,
Speaker 4: more accurate and faster diagnostic tools and better treatment options.
Speaker 4: There are some that are like being fast tracked, and
Speaker 4: you know we're trying. There is actually a new drug
Speaker 4: approved for I believe it's approved for recurrent volvovaginal candidiasis. Okay,
Speaker 4: that just got approved a couple of years ago. I
Speaker 4: guess it reduces adverse reactions compared to fluconazol, but it
Speaker 4: doesn't necessarily help with asal resistance. Another thing that's commonly
Speaker 4: used for volvo vaginal infections is boric acid. Boric acid
Speaker 4: like vaginal suppositories. It's quite effective. It's like a broad
Speaker 4: spectrum antimicrobial, and it generally is pretty safe and well tolerated,
Speaker 4: but it's not like approved for use by the FDA.
Speaker 4: It's also not commonly in Canada or the EU, so
Speaker 4: it's actually really hard to get access to, like you
Speaker 4: have to go through a compounding pharmacy or you have
Speaker 4: to make your own suppositories. I don't really understand why,
Speaker 4: Like I guess nobody, no pharmaceutical company has bothered to
Speaker 4: try and make a profit off of it.
Speaker 3: Is that the answer?
Speaker 4: I don't know.
Speaker 3: Yeah, maybe it's like in public domain or whatever, like.
Speaker 4: Right, did you mean, like why can't you just get
Speaker 4: a subpository? But I don't know.
Speaker 3: I feel like I remember and I'm probably going to
Speaker 3: like completely butcher this recollection because my memory is not good.
Speaker 3: But in so the last season, I did a book
Speaker 3: Club episode on vagina obscura with Rachel Gross. She's amazing,
Speaker 3: and in her book she talks about using a vaginal
Speaker 3: microbiome transplant kind of like fecal transplants. Yeah for but
Speaker 3: I don't know if it was to treat recurrent yeast
Speaker 3: infections or like a really persist at BV. But anyway,
Speaker 3: I loved that idea.
Speaker 4: I love all of the ideas that are looking more
Speaker 4: at our microbiome and our microbial communities and how they interact,
Speaker 4: because we know that that's such a big driver of
Speaker 4: these kinds of overgrowth infections, opportunistic infections. So I don't
Speaker 4: know a lot about that, but it's really interesting to
Speaker 4: look into and I.
Speaker 3: Feel like we were I was a little bit like
Speaker 3: down on probiotics or like that's maybe the impression that
Speaker 3: I gave, and I'm I'm not, like, I think there's
Speaker 3: a lot of potential. I just don't think we're at
Speaker 3: the stage where we can say this will do this.
Speaker 4: No, And we're definitely not at the stage of saying
Speaker 4: put yogurt in your vagina. This is not a medical
Speaker 4: advice podcast, No, No, there is though. Also people are
Speaker 4: working on a vaccine for recurrence bagelal canadiasis specifically. It's
Speaker 4: an interesting type of vaccine because it is based on
Speaker 4: like a Canada protein of some kind. But the idea
Speaker 4: at least who they're targeting right now, like who they're
Speaker 4: testing it on, is people who've had recurrent infections, so
Speaker 4: it's kind of like to reduce the risk of recurrence
Speaker 4: rather than just like something to give to the whole
Speaker 4: pop or something like that. But yeah, it's really promising.
Speaker 4: I think the last paper that I saw on it,
Speaker 4: which might have been a year or two old, now,
Speaker 4: they were in stage two trials, so I don't know
Speaker 4: if they've moved further from that. And then there's also
Speaker 4: a new type of anti fungal that was recently approved.
Speaker 4: And the reason for invasive infections, and the reason that's
Speaker 4: exciting is because it's a easier to administer. You don't
Speaker 4: have to do it daily. You can do it once
Speaker 4: weekly and you can kind of front load it, which
Speaker 4: means because the other thing, and I didn't even get
Speaker 4: into this because there's so many components you could talk
Speaker 4: about when it comes to invasive candidiasis, these systemic infections,
Speaker 4: the long term sequelae of them can be really severe,
Speaker 4: and there's not enough research into the quality of life
Speaker 4: effects that we see after a systemic infection, but they're
Speaker 4: really substantial. You know, if it gets into the eye,
Speaker 4: it can cause permanent blindness. People tend to be really
Speaker 4: sick before they even get a fungal infection, and so
Speaker 4: then the recovery from that, like from a prolonged hospitalization
Speaker 4: or ICU state is really substantial. So the fact that
Speaker 4: people are working on trying to make treatment so that
Speaker 4: it could potentially be done more in the outpatient setting
Speaker 4: is really really huge and important. So there's a lot
Speaker 4: more that you can read about when we tell you
Speaker 4: about our sources.
Speaker 3: Sources time, Okay, Okay, let's see I have several a bunch,
Speaker 3: but I'm going to shout out too in particular. So
Speaker 3: one is a book titled Fungal Disease in Britain and
Speaker 3: the United States eighteen fifty to two thousand by AA
Speaker 3: Homie and Michael war Boys. And then there was oh,
Speaker 3: if you're interested in reading, like a paper about this
Speaker 3: nice statin relationship and like the ant the hypersensitivity candidis
Speaker 3: is hypersis city syndrome. There was a paper from nineteen
Speaker 3: ninety published and I feel like it was the New
Speaker 3: England Journal of Medicine that studied the administration of nistatin
Speaker 3: and whether it relieved any symptoms and like anything like that,
Speaker 3: and it's called it's by Dysmute's a randomized double blind
Speaker 3: trial of nystatin therapy.
Speaker 6: Love it.
Speaker 4: I had a number of papers for this, one of
Speaker 4: my favorites just for an overview of Canada was Nature
Speaker 4: Reviews Disease Primers from twenty twenty four called Invasive Candadiasis.
Speaker 4: I also loved a couple of papers I had about
Speaker 4: the like Virulence, but my favorite, I think was from
Speaker 4: the journal Virulence Who Knew in twenty twenty two titled
Speaker 4: Pathogenesis and Virulence of Canada Albacans. And then I have
Speaker 4: several on the introduction and emergence of some of these
Speaker 4: other species of Canada and what used to be Canada.
Speaker 4: And then the paper that was really great on recurrent
Speaker 4: volvo vaginal candidiasis was called Global Burden of Recurrent volvo
Speaker 4: vaginal Candidiasis, a systemic review in the Lancet Infectious Diseases
Speaker 4: from twenty eighteen. But I've got more and you can
Speaker 4: find all of them on our website. This podcast with
Speaker 4: killya dot Com under the episode stap.
Speaker 3: You certainly can a big thing. Thank you again to
Speaker 3: the provider of our first hand account. It really means
Speaker 3: so much for us and other people to hear your story.
Speaker 3: We appreciate it. Yeah, thank you.
Speaker 4: Thank you.
Speaker 3: Thank you also to Bloodmobile for providing the music for
Speaker 3: this episode and all of our episodes.
Speaker 4: And thank you to Leanna and Tom and Brent and
Speaker 4: Pete and Jessica and everyone else. I'd exactly write Network
Speaker 4: for help you make this podcast and the video.
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Speaker 3: the world to us, like we do this for you,
Speaker 3: and it means so much that you actually tune in
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Speaker 4: Thank you, so, thank you.
Speaker 6: Well.
Speaker 3: Until next time, wash your hands you feel the animals.
Speaker 7: On um U