Page 66 - Retail Pharmacy Assistants - October 2020

64 ANTIFUNGAL FROM PAGE 62 She highlights that often an incorrect diagnosis of Candida can be made for patients with intestinal symptoms who could be suffering from IBS, or a lactose or gluten intolerance. IBS symptoms, which include changes in frequency or form of bowel movements and lower abdominal pain, can initially occur due to food poisoning (25 per cent) or after courses of antibiotics, which can upset the balance of helpful bacteria in the gut and leave room for the growth of intestinal yeasts, Mr Webster says. Stress, diet (including food intolerances), poor sleep and changes in gut bacteria can all trigger symptoms such as diarrhoea and constipation, cramping and pain, gas and bloating, tiredness, difficulty sleeping, and depression and anxiety. However, overgrowth of Candida is rarely found within the intestines, except in people whose immune system is badly compromised. According to Dr Brewer, one theory is that the presence of Candida yeasts may trigger immune responses that result in intestinal symptoms similar to those of food intolerances. “An astounding 178 different proteins that can trigger immune reactions have been identified in Candida species, including proteins in their outer wall and the enzymes they secrete,” she said. “Although their role is unclear, a review published in the European Journal of Gastroenterology and Hepatology suggested this might explain why intestinal symptoms can worsen after eating mould-containing foods. “It might also explain why many people with IBS, and those with recurrent vaginal Candida, find probiotic supplements so helpful.” Dr Brewer says probiotic bacteria secrete lactic acid, which suppresses yeast growth, and can also compete for available nutrients and attachment sites on intestinal walls. “Probiotics also reinoculate the bowel with friendly digestive bacteria and suppress the gas-forming bacteria that have been associated with some cases of irritable bowel syndrome,” she said. Helpful nutritional supplements Dr Brewer suggests include vitamin C, vitamin D, biotin, iron, magnesium, selenium, zinc, artichoke, caprylic acid, co-enzyme Q10, cranberry, curcumin, echinacea, garlic, grapefruit seed, olive leaf, peppermint oil and Siberian ginseng. Dietitian unconvinced of IBS link Accredited Practising Dietitian Geraldine Georgeou tells Retail Pharmacy Assistants it’s impossible to make “facile” links between Candida and IBS and tackle the condition from this association. Having practised as a dietitian for more than 20 years, been a board member of the Gut Foundation and co-authored The Gut Foundation Cookbook, she says an antifungal diet could work for IBS patients, keeping in mind that they could have many other conditions, such as coeliac disease or a condition that has to be diagnosed via their GP or gastroenterologist. “I’ve had patients in their 30s who present with something that doesn’t appear to be sinister, such as constipation, who in fact have colorectal cancer, or patients who think they may have overflow diarrhoea but are constipated,” Ms Georgeou said. “This makes it clear the extent to which healthcare professionals have to be mindful as to how long the person’s been struggling with the condition and what’s actually going on with their health to bring them to the point where they enter a pharmacy and ask for assistance. “I can’t emphasise enough how much caution should be taken in avoiding the ease of oversimplifying medical conditions.” Ms Georgeou highlights that a quick means of gaining clarity is to refer patients to their GP for a stool test or to make use of the Microba Insight test, which comes in the form of a microbiome test kit that provides detailed insights into the microorganisms inhabiting a patient’s gut and how they function. “It’s a powerful, evidence-based tool that enables patients to learn about their unique microbial community in as yet unknown detail and identify dietary suggestions that could improve overall health and wellbeing,” she said. “Overall, though, I don’t see Candida as a presenting issue for IBS.” Ms Georgeou points out that IBS could follow a patient adopting a “crazy diet” with little to no fibre that results in an imbalanced gut microbiome, and “A Microba insight test is a powerful, evidence based tool that enables patients to learn about their unique microbial community ... and identify dietary suggestions that could improve overall health and wellbeing.” RETAIL PHARMACY ASSISTANTS • OCT 2020