Candida Overgrowth

Candida albicans is a normal resident of your gut, until it's not.1 When it overgrows, it forms protective biofilms and causes infection: most often thrush in the mouth or a vaginal yeast infection and, in people who are seriously ill, invasive infection.

Gut & Digestive Evidence-Based

Last updated:

โš ๏ธ Before you treat this as Candida, rule out what causes Candida. Recurrent yeast infections, thrush in an adult and repeated nail or skin fungal infections are classic presenting signs of undiagnosed diabetes, and high blood sugar is what feeds the yeast. If you have recurrent infections, particularly alongside fatigue, thirst, urinating more or unexplained weight change, ask for an HbA1c before you change your diet. Thrush in an adult with no obvious cause, such as inhaled steroids, dentures or a recent antibiotic course, also warrants checking for other causes of a suppressed immune system. Candida in the esophagus, causing pain on swallowing, needs medical assessment rather than a diet. Treating the yeast without finding what allowed it is how a diabetes diagnosis gets delayed.2

What Is Candida?

Candida albicans is a dimorphic fungus: it switches between a harmless yeast form and an aggressive, hyphal (root-like) form that invades tissue and evades the immune system.

In a healthy gut, Candida is kept in check by beneficial bacteria, stomach acid and a competent immune system. Infection becomes more likely after antibiotics, with immune suppression, poorly controlled diabetes, steroids or dentures.

It can affect the gut, vaginal tract, oral cavity (thrush), skin, nails, sinuses and, in severe cases, the bloodstream (candidemia, the fourth most common cause of hospital-acquired bloodstream infection in a large US surveillance study17).

โš ๏ธ Candida produces acetaldehyde and gliotoxin. Both are real compounds with real effects in the laboratory; what is not established is that they reach levels in a healthy person's gut that cause the symptoms attributed to them.
A close-up circle of Candida yeast cells and their thread-like hyphae, beside panels on where it causes infection, the mouth, vagina, skin and nails, and what it has not been shown to cause, brain fog, fatigue and mood problems
💡 Key Insight: An estimated 75% of women will have at least one episode of vulvovaginal candidiasis, and 40 to 45% will have two or more12. (Source: CDC, Sexually Transmitted Infections Treatment Guidelines, Vulvovaginal Candidiasis.)

Candida by the Numbers

75%
of women have a vaginal yeast infection at least once (CDC)12
#4
most common cause of hospital-acquired bloodstream infection, in a US study of 24,179 cases17
Most
healthy people carry Candida in the gut as a normal resident1
40 to 45%
of women have two or more vaginal yeast infections (CDC)12
138 million
women worldwide have recurrent vaginal yeast infections in any one year, by a review's definition of four or more episodes a year13
42.9%
of women with recurrent vaginal yeast infections were still free of them 6 months after stopping 6 months of weekly antifungal treatment11

Symptoms of Candida

The symptoms attributed to Candida are nonspecific. They are common and have many causes, which makes a gut Candida overgrowth easy to over-diagnose and the real cause easy to miss.

SymptomWhat happens
Digestive & Physical Symptoms
White Tongue / Oral ThrushA white, creamy coating on the tongue, inner cheeks or throat is oral thrush, which is a genuine Candida infection of the mouth. It can burn and alter taste, and in severe cases it spreads to the esophagus and makes swallowing painful. In an adult with no steroid inhaler, recent antibiotics or dry mouth to explain it, thrush is a reason to be checked for diabetes or immune suppression, not evidence of an overgrowth in the gut.
Bloating, Gas & Digestive DistressBloating and gas are common and nonspecific. Gut Candida has not been shown to cause them, and IBS, celiac disease and food intolerances are far more likely explanations.
Nail & Skin Fungal InfectionsThickened, yellowed or brittle nails, athlete's foot, jock itch and ringworm are fungal infections of the skin and nails. Most are caused by dermatophytes rather than Candida, and Candida rashes in warm, moist skin folds are treated where they are.
Recurrent InfectionsVaginal yeast infections three or more times a year, recurrent urinary infections and repeated sinus infections are worth investigating rather than treating one at a time. The first questions are diabetes and immune suppression, which is where this pattern most often leads.
Neurological & Hormonal Symptoms
Severe Brain Fog & Cognitive ImpairmentMental cloudiness and poor concentration are real, but gut Candida has not been shown to cause them. They are more often sleep debt, anemia, thyroid disease, depression or ADHD, each of which is testable and treatable.
Mood Swings, Anxiety & DepressionNo link between gut Candida and depression or anxiety has been established. If mood is the main problem, it deserves treating as the main problem.
Joint Pain & Muscle AchesCandida can infect a joint, but almost only in people who are seriously ill or who have a prosthetic joint, and it presents as one hot, swollen, painful joint needing a same-day appointment. Migrating aches in someone otherwise well are not explained by Candida, and are more often inflammatory arthritis, fibromyalgia or thyroid disease.
Hormonal DisruptionCandida does not make hormones, but pregnancy and hormonal contraception make vaginal yeast infections more likely (see Causes). Heavy or painful periods belong with endometriosis, PCOS or thyroid disease, each of which has its own workup.

Causes of Candida

Candida lives harmlessly in most people, and infection follows when something shifts the balance1. The causes below are the established ones; a diet-driven gut overgrowth causing body-wide symptoms is not established.

CauseHow It Contributes to CandidaWhat Helps
AntibioticsAntibiotic courses are a recognized trigger for yeast infections of the mouth or vagina1, and frequent antibiotic use is one of the factors behind recurrent vaginal yeast infections12.Standard antifungal treatment of each episode10; if a yeast infection follows every course, tell the prescriber (conventional care)
Diabetes and high blood sugarRaised glucose in tissues and secretions supports fungal growth, and recurrent yeast infections and thrush in an adult are recognized signs of undiagnosed diabetes2.An HbA1c test, then blood sugar control, the one route by which diet is shown to help (Nutritional Strategy)
A weakened immune systemHIV, immunosuppressive medicines including corticosteroids, and other immune deficiencies make infection more likely and harder to treat12; thrush in the esophagus warrants an HIV test2.Medical assessment of the underlying cause (conventional care)
Steroid inhalers and denturesLong-term inhaled corticosteroids suppress immunity locally in the mouth and are linked to mouth and throat thrush, especially at high doses or with poor inhaler technique14.A spacer, rinsing the mouth after each dose, good inhaler technique and denture care (conventional care)
Pregnancy and hormonal changesPregnancy, hormone replacement therapy and birth control pills are recognized risk factors for vaginal yeast infections15.A clinician-confirmed diagnosis and standard treatment, which in pregnancy a clinician chooses (conventional care)
Catheters and serious illness in the hospitalIn people who are seriously ill, central venous catheters are commonly linked to Candida bloodstream infection16.Intravenous antifungal treatment in the hospital and early removal of the infected catheter (conventional care)

How Candida Is Diagnosed

No test distinguishes normal gut Candida from a disease-causing overgrowth, because Candida is normally present. Testing is most useful for the conditions that cause thrush, such as diabetes.

TestWhat it shows
At-Home Screening
The Spit Test (Saliva Test)This test does not work, and here is why. You may have seen it: spit into a glass of water on waking and watch for strings or cloudy specks. Saliva does this in nearly everyone. It is ordinary mucin behaving normally in water, and what you see varies with hydration, time of day and how long you watch. It has never been validated against any laboratory measure of Candida, and a positive result tells you nothing. It is described here only because it circulates widely, and a restrictive diet started on its strength costs something for no information.4
Candida Symptom ScoreChecklists of symptoms such as sugar cravings, fatigue, brain fog and bloating circulate widely. They do not diagnose Candida overgrowth, and every symptom on them has more common explanations, including diabetes, thyroid disease, iron deficiency, celiac disease, sleep apnea and depression. Use the score as a reason to get tested for those, not as a result.3
The Sugar ChallengeThis is an observation, not a test. A crash after a high-sugar meal happens to most people and does not identify Candida. Worsening after sweets, alcohol or refined carbohydrate is worth mentioning to a clinician, but it points at blood sugar at least as often as it points at Candida.
Lab & Clinical Tests
Stool DNA TestMeasures what is present. Since Candida is normally present, a positive result does not show an overgrowth.
Candida Antibody Blood PanelInterpret with care: most people carry Candida antibodies from normal colonization, so a positive result does not by itself indicate overgrowth.5
Organic Acids Test (OAT)A urine test that measures metabolic byproducts of Candida and other organisms. These are not validated diagnostic markers for Candida overgrowth. Urinary arabinose in particular has substantial dietary sources, so an elevated result does not establish a fungal cause.5
Comprehensive Blood PanelAsk your doctor to run: blood glucose/HbA1c (high blood sugar feeds Candida), a complete blood count and a thyroid panel (thyroid disease explains many of the same symptoms).

Conventional and Holistic Treatment for Candida

๐ŸŒฟ HOLISTIC
๐Ÿ’Š CONVENTIONAL
๐ŸŒฟ

Holistic / Functional Approach

Antifungal botanicals and diet changes, none tested in trials for this use

Primary Antifungals
Caprylic acid, undecylenic acid, pau d'arco, berberine, oregano oil
Duration
Commonly promoted as several months, with a restrictive phase and reintroduction; no trial has tested a duration
Relapse Rate
Not established; no trial has measured relapse after this protocol
Biofilm Strategy
Biofilm disruptors are not shown to work in the human gut

Full Holistic Approach Includes

  • Caprylic acid (1,000 to 2,000 mg with meals), derived from coconut oil, disrupts Candida cell membrane
  • Undecylenic acid (200 mg 3x/day), fatty acid with antifungal activity, not tested in trials for gut Candida
  • Berberine (500 mg 2 to 3x/day), disrupts Candida morphology transition to hyphal form; it interacts with many prescription medicines, so check with your prescriber first
  • Pau d'arco tea / capsules, traditionally used for fungal infections, though the evidence for its products is insufficient; lapachol, one of its compounds, has an anticoagulant effect through vitamin K, so check with your prescriber first if you take a blood thinner19
  • Saccharomyces boulardii 250 to 500 mg (about 5 to 10 billion CFU) a day, probiotic yeast that competes with Candida. Use caution with a weakened immune system or a central line, as bloodstream infections from probiotics have been reported; agree on it with your team.
  • An anti-Candida diet, commonly promoted for 4 to 8 weeks; diet has not been shown to treat Candida except through better blood sugar control in diabetes
  • Molybdenum (500 mcg/day), a cofactor for the enzyme that metabolizes acetaldehyde; there is no evidence it helps Candida symptoms, and the adult upper limit is 2,000 mcg a day
โš ๏ธ Feeling worse is not a sign it is working. The Herxheimer reaction is described in spirochetal infections, not in dietary Candida treatment.7 If you feel significantly worse on any protocol, stop and seek review.

Evidence-Based Supplements for Candida

None of these supplements has been tested in trials for gut Candida. Check interactions with your prescriber before starting any of them.

SupplementWhat it is forTypical rangeTimingNotes & cautions
NAC (N-Acetyl Cysteine)Studied as a biofilm disruptor. Breaks down the polysaccharide matrix of Candida biofilms in laboratory work. Biofilm-grown Candida is far less susceptible to antifungals than free-floating cells, with resistance commonly reported up to around 1,000-⁠fold, but no trial has shown that taking NAC by mouth makes antifungal treatment more effective in people, and no multiplier of that kind has been demonstrated.6 Also replenishes glutathione for liver and immune support.600 to 1,200 mg/dayOn an empty stomachNo evidence that timing relative to other supplements matters
Oregano OilCarvacrol and thymol, the active compounds in oregano oil, disrupt Candida's cell membrane and inhibit the transition from yeast to invasive hyphal form.100 to 200 mg/day (standardized to 70%+ carvacrol)With meals; enteric-coated capsulesEnteric coating essential for delivery to the gut (not the stomach)
Allicin (Garlic Extract)Allicin is directly antifungal: it disrupts Candida's cell wall synthesis and inhibits its morphological switch to the invasive hyphal form. Raw garlic contains allicin; no dose has been shown to treat Candida in people.450 to 900 mg/dayWith mealsGarlic supplements may increase the risk of bleeding: check with your prescriber first if you take a blood thinner or other medicines that affect bleeding, or before surgery. Taken in amounts above those in food, garlic may not be safe in pregnancy or breastfeeding20.
BerberineInhibits Candida biofilm formation, disrupts cell wall integrity and prevents Candida from switching to its virulent hyphal form. Also lowers blood sugar, which matters if you take glucose-lowering medicine.500 mg 2 to 3x/dayWith mealsMonitor blood sugar; can lower glucose levels.8 Berberine inhibits CYP3A4 and P-glycoprotein, so it can raise blood levels of many prescription medicines, and it lowers blood sugar on its own. Check with your prescriber before starting it, particularly alongside glucose-lowering medication, an anticoagulant, an immunosuppressant or any drug with a narrow safe range. Not for use in pregnancy or breastfeeding.
Ceylon CinnamonCinnamaldehyde inhibits Candida growth and biofilm formation. Whether cinnamon supplements help blood sugar in diabetes is unclear21. Ceylon cinnamon contains compounds that interfere with Candida's ergosterol synthesis (the same target as pharmaceutical antifungals).1 to 2 g/dayWith meals or in morning drinkMust be Ceylon cinnamon ONLY; cassia contains high coumarin (liver toxic at these doses)
Saccharomyces boulardiiA probiotic yeast whose secretions, in laboratory work, include caprylic and capric acid and reduce Candida's hyphae formation, adhesion and biofilm development. As a yeast itself, it is susceptible to antifungal medicines23.250 to 500 mg (about 5 to 10 billion CFU) a dayBetween meals; 2+ hours from antifungalsAntifungal medicines are active against it, so ask your prescriber before taking it alongside antifungal treatment23. Use caution with a weakened immune system or a central line, as bloodstream infections from probiotics have been reported; agree on it with your team.
Milk Thistle (Silymarin)Silymarin protects hepatocytes (liver cells), and is widely used for liver support. Its human trial evidence is limited, and the "phase I and phase II detoxification" framing describes real enzyme systems but has not been shown to clear mycotoxins in people.300 to 600 mg/day (standardized to 80% silymarin)With dinner or before bedNot established for this use
TUDCA (Tauroursodeoxycholic Acid)A bile acid supplement that affects bile flow. TUDCA also has anti-inflammatory effects in the gut. Its effect on cellular stress is laboratory work, not a demonstrated benefit in this setting.250 to 500 mg/dayWith fat-containing mealsNot established for this use. If you have gallstones, or have never been checked for them, agree on this with your clinician first: gallstones are common and usually silent, and deliberately stimulating gallbladder contraction when stones are present can trigger biliary colic or block a bile duct.
Aloe Vera JuiceOral aloe is promoted for inflammatory bowel disease, diabetes and weight loss, but it has not been tested in trials for Candida, and the idea that Candida irritates the gut lining in otherwise healthy people is not established. It may lower blood sugar, which matters if you take glucose-lowering medicine, and taken by mouth it may be unsafe in pregnancy and breastfeeding22.2 to 4 fl oz (60 to 120 mL)/dayMorning fasted or before mealsInner leaf fillet only; avoid whole-leaf products containing aloin (a laxative)
Apple Cider Vinegar (ACV)Malic acid and acetic acid in raw ACV have documented antifungal properties against Candida.1 to 2 tbsp in water/dayBefore meals; from week 5 if you follow the diet's first phase, which leaves out vinegar for 4 weeksRaw, unfiltered with "mother." Dilute well. Avoid if you have acid reflux or esophageal Candida.
Curcumin (Turmeric Extract)Inhibits hyphae formation, the invasive form, in laboratory work, and is an anti-inflammatory in its own right. It is not established that Candida toxins drive systemic inflammation in an otherwise healthy person, so treat this as general support rather than as treatment of a cause.500 to 1,500 mg/dayWith fat-containing mealsLiver injury has been reported mainly with high-dose, high-absorption formulations such as those with piperine, so stop and seek advice if you notice dark urine or yellowing skin.
Omega-⁠3 Fish OilEPA and DHA are anti-inflammatory. The claim that they counter inflammation from Candida mycotoxins specifically is not established.2 to 3 g combined EPA+DHA/dayWith mealsChoose a third-party tested product; enteric-coated reduces fishy aftertaste. At this dose use fish or algal oil rather than cod liver oil, which also supplies preformed vitamin A, whose adult upper limit is 3,000 mcg a day24. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day25, so check this dose with your clinician first.

What to Expect Over Time

Most mouth thrush and vaginal yeast infections are treated with a short antifungal course; recurrent infection takes months, and finding what allowed it comes first.

Treatment and supportive care, together
First Weeks

An uncomplicated vaginal yeast infection is treated with a single oral antifungal dose or a short topical course10, and mild mouth thrush with 7 to 14 days of treatment16. Recurrent infection is a reason for an HbA1c test for diabetes2.

Months 1 to 3

Symptoms that persist after an over-the-counter treatment, or return within 2 months, need examination and testing by a clinician12. For recurrent vaginal yeast infections, 10 to 14 days of initial treatment is followed by a weekly oral antifungal for 6 months10.

Months 3 to 12

In a trial of weekly maintenance treatment, 90.8% of women were free of symptoms at 6 months. After it stopped, 73.2% were at 9 months and 42.9% at 12 months, against 21.9% on placebo11.

Long Term

Recurrence after maintenance is common: the median time to a recurrence was 10.2 months, against 4.0 months on placebo11. Managing what allowed the infection, such as blood sugar in diabetes2 or inhaler technique14, is part of long-term care.

When to Seek Care

Pain on swallowing suggests thrush in the esophagus, which always needs antifungal medicine by mouth or vein and an HIV test162. See a clinician for thrush with no clear cause, or with thirst, frequent urination or weight change2. If you feel significantly worse on any protocol, stop and seek review7.

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Find What Allowed the Yeast

Recurrent infections are a reason to check for diabetes and immune suppression before you change your diet. Prescription antifungals treat the infection, and diet has not been shown to help except through better blood sugar control in diabetes. Pain on swallowing needs medical assessment.

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.9 Candida infections are real, diagnosable and treatable: oral thrush, vaginal yeast infections, esophageal candidiasis and invasive candidiasis are all well-defined conditions with established treatments. What is not an established diagnosis is the broader idea that a chronic systemic Candida overgrowth explains fatigue, brain fog, mood problems and food sensitivities in otherwise healthy people. That framework has been examined and is not accepted in mainstream practice, and the tests commonly sold to confirm it do not measure what they claim to. The diet described here (less added sugar and refined starch, more vegetables) is sensible eating whose merits do not depend on the theory. But this is education about a contested idea, not a diagnosis, and if your symptoms are real and persistent they deserve a real workup rather than a restrictive diet.

  1. On what Candida is: Candida albicans and related species are normal commensal organisms of the mouth, gut and vagina in most healthy people. Their presence is expected, and detecting them does not indicate disease. Candidiasis occurs when the balance shifts, usually after antibiotics; other triggers are immunosuppression, poorly controlled diabetes, inhaled or systemic corticosteroids, dentures and infancy. The distinction between colonization and infection is central to everything on this page. ↩
  2. On the differential that matters most: recurrent vulvovaginal candidiasis, oral thrush in an adult and recurrent cutaneous or nail fungal infection are recognized presenting features of undiagnosed or poorly controlled diabetes mellitus, because elevated glucose in tissues and secretions supports fungal growth. The combination of recurrent yeast infections with the fatigue and sugar cravings found on Candida symptom checklists overlaps almost exactly with the presentation of new type 2 diabetes. An HbA1c is inexpensive and settles it. Separately, oral candidiasis in an adult with no local cause, and esophageal candidiasis in particular, raise the question of immunosuppression; esophageal candidiasis is an AIDS-defining illness and warrants HIV testing. Attributing these presentations to a dietary overgrowth without excluding diabetes and immunosuppression is the most consequential error to avoid. ↩
  3. On symptom checklists: fatigue, brain fog, bloating, sugar cravings, mood changes and multiple food sensitivities are nonspecific. Each is more commonly explained by iron deficiency, thyroid disease, diabetes, celiac disease, obstructive sleep apnea, depression, anxiety, perimenopause or simple sleep deprivation than by fungal overgrowth. A scored questionnaire built from nonspecific symptoms will return a positive result for a large share of the general population, which is why it cannot function as a diagnosis. It is a reason to investigate, and the investigation should start with the common causes. ↩
  4. On the saliva or "spit" test: there is no published validation of this test against culture, microscopy or any other laboratory measure. Saliva contains mucins that form strands and settle in water in most people, and the appearance changes with hydration, time since waking and observation time. It is not a weak test; it is not a test. It is worth knowing about because it circulates widely and leads people into restrictive eating on the basis of nothing. ↩
  5. On the tests sold to confirm overgrowth: Candida antibody panels detect an immune response to an organism that normally colonizes most people, so a positive result is expected in health and does not establish overgrowth. Urinary organic acid markers such as arabinose and D-arabinitol have not been validated as diagnostic for gut Candida overgrowth, and urinary arabinose has substantial dietary contributions. Stool culture can confirm Candida is present, which it usually is. None of these distinguish colonization from the syndrome the page describes. ↩ ↩
  6. On biofilms: Candida genuinely forms biofilms, and this is well documented on indwelling medical devices such as catheters and prosthetic valves, where it makes infection markedly harder to clear. That laboratory and device-related biology is real. Whether oral supplements marketed as biofilm disruptors alter Candida biofilms in the human gut has not been established in clinical trials, and the leap from device biofilms to a gut supplement protocol is an inference rather than a finding. ↩ ↩ ↩
  7. On "die-off": the Jarisch-Herxheimer reaction is a genuine, well-characterized phenomenon, but it is described in spirochetal infections such as syphilis and Lyme disease treated with antibiotics, not in dietary or supplement treatment of Candida. No equivalent reaction has been characterized here. This matters practically rather than academically: a framework in which feeling worse is evidence the treatment is working removes the ordinary signal that something is wrong. If you feel significantly worse on any protocol, treat that as a reason to stop and seek review, not as proof of progress. ↩
  8. On berberine: berberine acts on cytochrome P450 3A4 and P-glycoprotein and can alter plasma concentrations of many co-administered drugs, PubMed 35048143. Most work reports inhibition, which raises drug levels, but at least one in vivo study of the whole herb reports the opposite effect, so the safe reading is that levels may move in either direction, and it has a clinically meaningful glucose-lowering effect. It should be avoided in pregnancy and breastfeeding, and in neonates and infants, where it displaces bilirubin from albumin, PubMed 8513024. Anyone taking prescription medication, and anyone being investigated for diabetes, should clear it with their prescriber before starting. ↩
  9. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
  10. On standard treatment of vaginal yeast infections: the 2016 IDSA candidiasis guideline recommends a topical antifungal or a single 150 mg oral azole dose for uncomplicated infection. For recurrent infection it recommends 10 to 14 days of induction treatment followed by a weekly 150 mg oral azole dose for 6 months, IDSA, 2016. ↩
  11. On recurrence after maintenance treatment: in a trial of 387 women with recurrent vulvovaginal candidiasis, a weekly oral azole for six months kept 90.8% disease-free at 6 months. After treatment stopped, the figure fell to 73.2% at 9 months and 42.9% at 12 months, against 21.9% with placebo, PubMed 15329425. ↩
  12. On vaginal yeast infections: US treatment guidelines estimate that 75% of women have at least one episode and 40 to 45% have two or more; recurrent infection, three or more episodes in a year, affects fewer than 5% of women and can follow frequent antibiotic use, diabetes or other host factors; infection in women with diabetes, HIV, immune deficiency or immunosuppressive treatment such as corticosteroids counts as complicated; and anyone whose symptoms persist after an over-the-counter treatment, or return within 2 months, should be examined and tested, CDC, Sexually Transmitted Infections Treatment Guidelines, 2021. ↩
  13. On how common recurrent vaginal yeast infections are: a systematic review of 8 population studies with 17,365 women in 11 countries estimated that recurrent vulvovaginal candidiasis, four or more episodes a year, affects about 138 million women worldwide each year, with the highest prevalence, 9%, at ages 25 to 34, PubMed 30078662. ↩
  14. On steroid inhalers and mouth thrush: a 2025 review found that prolonged use of inhaled corticosteroids is associated with mouth and throat thrush through local immune suppression, with high doses, poor oral hygiene and poor inhaler technique as key risk factors, and spacers, rinsing the mouth after each dose and denture care as preventive measures, PubMed 40724743. ↩
  15. On risk factors for vaginal yeast infections: a review lists pregnancy, hormone replacement therapy, uncontrolled diabetes, immunosuppression, antibiotics, corticosteroid use and genetic predisposition as host factors, and oral contraceptives, intrauterine devices and spermicides among behavioral ones, PubMed 26690853. ↩
  16. On treating other forms of candidiasis: the 2016 Infectious Diseases Society of America guideline recommends 7 to 14 days of treatment for mild mouth thrush, states that thrush in the esophagus always needs systemic antifungal treatment, usually for 14 to 21 days, and notes that central venous catheters are commonly linked to Candida bloodstream infection and should be removed early when they are the likely source, IDSA, 2016. ↩
  17. On Candida among hospital-acquired bloodstream infections: a US surveillance study of 24,179 hospital-acquired bloodstream infections in 49 hospitals from 1995 to 2002 found Candida species the fourth most common cause, at 9% of isolates, after coagulase-negative staphylococci, Staphylococcus aureus and enterococci, PubMed 15306996. ↩
  18. On Candida auris: it is often resistant to one or more classes of antifungal medicine, and cases resistant to all three commonly prescribed classes have been reported in several countries, including three patients in New York in whom the resistance developed during antifungal treatment, PubMed 31917780. ↩
  19. On pau d'arco: the inner bark is traditionally used for fungal and other infections, but a review found the scientific evidence for its products insufficient and named interference with vitamin K as one of its most important interactions, PubMed 18992801; lapachol, one of its compounds, inhibits the same vitamin K enzymes as coumarin anticoagulants, which explains the anticoagulant activity seen in animals and people, PubMed 6497379. ↩
  20. On garlic supplements: the National Center for Complementary and Integrative Health notes that garlic supplements may increase the risk of bleeding, which matters before surgery and for anyone taking anticoagulants or other medicines that affect bleeding, that people taking any medicine should talk with a healthcare provider first, and that garlic taken by mouth in amounts above those in food may not be safe in pregnancy or breastfeeding, NCCIH, garlic. ↩
  21. On cinnamon: the National Center for Complementary and Integrative Health notes that cinnamon has been studied often for diabetes and that it is unclear whether supplementation helps, and that some cassia cinnamon products contain high levels of coumarin, a concern for people with liver disease, NCCIH, cinnamon. ↩
  22. On aloe taken by mouth: the National Center for Complementary and Integrative Health notes that oral aloe is promoted for weight loss, diabetes and inflammatory bowel disease, that a small amount of research suggests it may reduce blood sugar in people with diabetes, that aloe latex can cause abdominal pain, cramps and diarrhea, and that aloe taken by mouth may be unsafe in pregnancy and breastfeeding, NCCIH, aloe vera. ↩
  23. On S. boulardii and Candida: in laboratory work an extract of S. boulardii culture, containing caproic, caprylic and capric acid, reduced Candida albicans hyphae formation, adhesion and biofilm development, with capric acid the main active compound, PubMed 20706577. S. boulardii is itself a yeast: isolates from seven people with bloodstream infection linked to the probiotic were susceptible to all antifungal agents tested, PubMed 28133894. ↩
  24. On cod liver oil: cod liver oil supplements provide vitamin A and vitamin D as well as omega-⁠3s, NIH Office of Dietary Supplements, omega-⁠3, and the adult upper limit for preformed vitamin A is 3,000 mcg a day, NIH Office of Dietary Supplements, vitamin A. ↩
  25. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩