>Not that the true believers will be persuaded – but THERE IS a nicely
>done RCT of oral nystatin for the "candida hypersensitivity" syndrome of
>vague systemic complaints.

>Yes, it showed no benefit.

>    A randomized, double-blind trial of nystatin therapy for the candidiasis
>     hypersensitivity syndrome.
>   New England Journal of Medicine, 1990 Dec 20, 323(25):1717-23.

Thank you for posting the citation for this study.  Unfortunately,
this study bears very little resemblence to the suggested treatment
protocol of the Yeast Syndrome proponents.

The "Mehtods" of the above-mentioned trial were summerized as
follows:

    To determine the efficacy of nystatin therapy for presumed
    candidiasis hypersensitivy syndrome, we conducted a ew-week
    randomized, double-blind, cross-over study using four different
    combinations of nystatin or placebo given orally orvaginally in 42
    premenopausal women who met preset criteria for the syndrome and had
    a history of candida vaginitis.  The outcomes studied were the
    changes from base line in scores for vaginal, systemic and overall
    symptoms and in the results of standarized psychological tests.

All that was done for the subjects were to give them nystatin for 32
weeks.

Dr. William Crook’s recommendation are extensive.  A very, very
short, and somewhat incomplete summary of his recommendations would
look something like this:

    1.  Diet  ("To control candida you must change your diet.")
        – "Avoid ‘junk’ foods–food which are refined, overly
           processed, loaded with sugar, salt…."
        – "Especially avoid all sugars, honey…."
        –  Avoid foods that cause allergic reactions.
        –  Eat complex carbohydrates (such as brown rice).
        –  Be sure to eat some protein-rich foods.
        –  Include limited amounts of essential fatty acids
                  and *many* other recommendations

    2.  Environment
        –  Avoid environmental pollutants in the air and water.
           (He goes into more detail on this subject)
        –  Get rid of mold out of one’s environment.

     3.  Miscellaneous
         - Get adequate sunlight.
         - Get fresh air.
         - Get pure (unpolluted water).
         - Get adequate exercise.
         - Get love & affection [psychoneuroimmunology, I suppose]

     4.  Candida treatment
         - Nyastatin
         - Garlic (allicin)
         - Caprylic Acid
         - Lactobacillus acidophilus

Even the authors of the study were aware of the fact that the study
design did not resemble Dr. Crook’s recommendations.  They decided to
only include Nystatin and nothing else due to the complexity of the
study.  Here is Dr. Crook’s response in NEJM and the authors’
response to Dr. Crook:

   Dr William G. Crook (NEJM, Vol. 324, No. 22, pp. 1592)

   To the Editor:  In his editorial "Searching for the Yeast
   Connection’ (Dec. 20 issue), Bennett noted, "The study by Dismukes et
   al. [Dec. 20 issue] was carefully designed and the data thoughtfully
   analyzed."  Yet, Bennett also said that this study "is only a
   beginning" and ‘will not end the controversy."  As the author of the
   controversial and often maligned book "The Yeast Connection", I would
   like to shine more light (and less heat) on the candida-related
   complex.

   First, I would like to commend Dismukes and associates for
   carrying out their study.  They showed, clearly, that nystatin alone
   "does not reduce systemic or psychological symptoms significantly
   more than placebo."  Does that mean that nystatin is of no value as
   part of a comprehensive treatment program for patients with fatigue,
   premenstrual tension, gastrointestinal symptoms, and depression?  In
   my experience and that of hundreds of other physicians and thousands
   of patients, the answer is a resounding no.  With few exceptions, a
   pateint with a chronic health problem requires multi-modal therapy —
   for example, a patient with coronary heart disease, diabetes,
   arthritis, or the attention-deficit disorder.  And as noted by
   Bennett, "None of the proponents have recommended the use of nystatin
   alone."

   Additional scientifically sound studies are desperately needed.  I
   hope that pharmaceutical companies or the National Institutes of
   Health will provide funds for carrying out such studies.  I would
   also urge interested investigators to do more shoe-leather detective
   work, which would include in-depth interviews with proponents of the
   syndrome and their patients.  I would especially urge the
   investigators to look at the important role (and intricacies) of
   diet.  A diet low in sugar (and other simple carbohydrates) was an
   essential part of the treatment program first outlines by Truss.
   Dietary modification was also noted to be important by Crook, Zerling
   et al., Schinfeld, Kroker, Hallowitz, and Jessop.  I would like to
   suggest that investigators review other reports that provide support
   for the relation between candida and defects and disturbances of the
   immune system and the endocrine system.

   Dr. William E. Dismukes (reply)  (NEJM, Vol. 324, No. 22, pp. 1594)

   To the Editor:  We appreciate the comments of Dr. Crook and agree
   that additional studies are indicated to address other issues
   relating to therapy, including diet.  Owing to the already complex
   design of our study, we purposely avoided dietary management as a
   treatment variable, but we acknowledge its potential role.
   ….

You may want to review several other letters that challenged
different aspects of the study design, some of which the authors
could not "unequivocally refute."

>Also, how does reducing sugar intake reduce candida colonization????
>Oral glucose is completely removed for the alimentary tract around the
>jejunum.  None of it makes it to the vagina.  Diabetics are prone to
>candida because of cellular immune defects not because they provide a
>sweet growth medium.

Good question.  Perhaps you can contact Dr. Crook and ask him
directly.  You may also want to contact John W. Rippon, Ph.D. of the
University of Chicago whom he interviewed for his book.  Also, Dr.
Crook seems to have gotten some of his information from a British
mycologist, Frank C. Odds, who wrote the book "Candida and Candiosis."

>As others have observed here, evaluation of subjective complaints
>REQUIRES double blinding.  Merely sticking to the rigors of a "Crook"
>dietary regimen may provide symptom relief to this poorly defined group
>of patients.

Unfortunately, it is very difficult to "double blind" all of Dr.
Crook’s recommendations.  As a first step, I would suggest a protocol
where the treatment group followed Dr. Crook’s recommendations as
closely as possible, while the control group was given the
traditional treatment (whatever that is for their particular
condition).  At least this way, we can tell if Dr. Crooks
recommendations have merit over a "traditional" treatment.

>All great ideas in medicine begin as anecdotes – they just don’t stop there.

I agree.  In addition, I think that the treatments that lead to these
anecdotal successes should, initially, be tested, "as is", and not picked
apart.

                              – Mark
                          g…@ilp.mit.edu

P.S. – I personally agree with many of Dr. Crook’s suggestions and
       *some* of his ideas.  Some of his suggestions, like the use of
       nystatin, I do not agree with.  (I think it’s too harsh–I prefer
       allicin and other treatments.)

[details of NEJM study]

>All that was done for the subjects were to give them nystatin for 32
>weeks.

First of all, congratulations for actually READING one of the references
posted here.  

[details of crook-therapy]

>Even the authors of the study were aware of the fact that the study
>design did not resemble Dr. Crook’s recommendations.  They decided to
>only include Nystatin and nothing else due to the complexity of the
>study.

Right.  As I said in my post – this article will not persuade the "true"
believer and is not a study of the whole Crook theory.  There is very
little in medicine that is all-or-nothing.  If there is truth to the
notion that oral nystatin reduces systemic "symptoms" of candida, and
this effect is large, then this should be observable.  Of course, the
effect may not be large when done in isolation without the other aspects
of crooktherapy.

This is the line defenders will take.  

Quoting Crook,

>   my experience and that of hundreds of other physicians and thousands
>   of patients, the answer is a resounding no.  With few exceptions, a
>   pateint with a chronic health problem requires multi-modal therapy —
>   for example, a patient with coronary heart disease, diabetes,
>   arthritis, or the attention-deficit disorder.  And as noted by
>   Bennett, "None of the proponents have recommended the use of nystatin
>   alone."

Exactly Dr. Crook.  And in each of these examples each individual "mode"
of therapy can be shown to have an effect on its own.  Frequently
interventions are synergistic (NSAIDS are good for arthritis pain, rehab
is good for arthritis pain, together they’re really good).

Nystatin alone is ineffective – of course nystatin + crooktherapy MAY be
effective, but this study makes this hypothesis less plausable unless the
"ingredients" in crooktherapy have persuasive face validity based on
biologic plausability.

So, do they???

Crook continues:

>   I would especially urge the
>   investigators to look at the important role (and intricacies) of
>   diet.  A diet low in sugar (and other simple carbohydrates) was an
>   essential part of the treatment program first outlines by Truss.

I wonder why this is?  Does Crook acknowledge the profound placebo effect
of a rigorous lifestyle regimen on functional symptoms?

>Unfortunately, it is very difficult to "double blind" all of Dr.
>Crook’s recommendations.  As a first step, I would suggest a protocol
>where the treatment group followed Dr. Crook’s recommendations as
>closely as possible, while the control group was given the
>traditional treatment (whatever that is for their particular
>condition).  At least this way, we can tell if Dr. Crooks
>recommendations have merit over a "traditional" treatment.

Nope.  The "correct" way to study Crook is to give one group crooktherapy
and the other group sham crooktherapy.  This would not be easy since many
folks seeking crooktherapy are already aware of its details.  But one
group could get some arbitrarily defined "lifestyle intervention" (I don’t
know – ask ronroth) and placebo nystatin.  There is no "traditional
treatment" for candida hypersensitivity because there is no agreement on
its existence or diagnostic criteria.

Of course, if you REALLY believe, no experiment will convince you.

Not that the true believers will be persuaded – but THERE IS a nicely
done RCT of oral nystatin for the "candida hypersensitivity" syndrome of
vague systemic complaints.  

Yes, it showed no benefit.

    A randomized, double-blind trial of nystatin therapy for the candidiasis
     hypersensitivity syndrome.
   New England Journal of Medicine, 1990 Dec 20, 323(25):1717-23.

Finally, the candida "hypothesis" makes no sense. There are a number of
well recognized allergic syndromes to endogenous fungal allergens.  These
do NOT respond to antifungal therapy.

Also, how does reducing sugar intake reduce candida colonization????
Oral glucose is completely removed for the alimentary tract around the
jejunum.  None of it makes it to the vagina.  Diabetics are prone to
candida because of cellular immune defects not because they provide a
sweet growth medium.

As others have observed here, evaluation of subjective complaints
REQUIRES double blinding.  Merely sticking to the rigors of a "Crook"
dietary regimen may provide symptom relief to this poorly defined group
of patients.

All great ideas in medicine begin as anecdotes – they just don’t stop there.

You’re right; the proper response is not to go to a "quack."  However, it
is a very proper response to take responsibility for your own health and
seek help from someone you trust.  It makes sense not to trust someone who
does not give you the proper time and sympathy.  Just because a health care
professional does have these qualities does not make her/him "quack."
Also, being dissatisfied with conventional doctors and taking an
"alternative" route does not mean that you are insisting on a certain
diagnosis.  It means that you are aware that there is expertise your
conventional doctor may not have tapped into yet that may be useful in your
situation.

Aren’t there tests which are based on the level of antibodies rather than
whether they exist?  I took such a test for candida and it came back claiming
I had a "high" level of antibodies to candida.  (Although I did not retake the
test last, which would have been interesting.)

Mark London
M…@PFC.MIT.EDU

: There is absolutely no high-quality peer-reviewed published research
: out there on the pseudo-diagnosis of "chronic candidiasis".  

Why isn’t there?

:If there were, we wouldn’t be having this discussion.

This seems to say you already know the outcome of research that would be done.

The posts against even considering the possibility that the anti-yeast
people are on to something seem far too intensely negative to just be
helpful skepticism.  What is the real agenda?

I just read three books on yeast stuff this weekend.  I am trying
the diet suggested.  What have I lost (aside from squashing a lot
of urges to eat fruit and Oreos) by trying it?  My health isn’t bad enough
for me to risk any prescription medicine that they talk about and the
diet hasn’t caused me to shell out any big bucks.

Why shouldn’t I do this?

–
Jay Brown hpgrla!jayb Greeley Hardcopy

- Hide quoted text — Show quoted text -

>In article <2se6ln$…@pipeline.com> inter…@pipeline.com (Richard
Sullens) writes:

>>I am one of those patients you so condescendingly refer to.  It
>>was suggested to me by a chiropractor that I may want to read
>>"The Yeast Connection" and to follow the diet since I was
>>experiencing many of the nearly debilitating symptoms which are
>>considered by Dr. Crook to be indicative of systemic or chronic
>>yeast infection.

>Chiropractors like to give nutritional advice.  It helps to compensate
>for the fact that they’re not allowed to prescribe drugs.

>> As far as "dollars and cents" are concerned,
>>I spent $30.00 on the chiropractic, $10.00 on the book, and
>>have spent about $100 on supplements over the past four years.  
>> After a few weeks on the diet, my numerous symptoms began to
>>fade and disappear.  Contrast this to many thousands of dollars
>>spent on conventional medical doctors who were completely
>>unable to help me or to discover the cause of my health
>>problems, and to hundreds of dollars spent on prescribed drugs,
>>which did nothing but make me sicker and poorer.  I have not
>>been following your discussion from the beginning, but I am
>>curious to know why you are so hostile towards those who are
>>willing to entertain that candida may be a cause of many
>>otherwise inexplicable health problems.  Even though a reliable
>>test has not yet been established, if one can improve their
>>health by following the recommended regimen when nothing else
>>has been successful, then it makes sense to give this route a
>>try. If I had not, I would probably not be here today.

>Nobody here is sorry that your health improved.  At least I think not.

>However, let’s look at the facts, as supplied by you.

>1)  You had health problems.  You don’t say what they were.

>2)  Various prescription drugs did not help.

>3)  Dr. Crook’s book seemed to describe your symptoms.

>4)  You decided to follow the recommendations in the book.

>5)  Your health improved.

>So far, this is ALL we know.

> * we don’t know that you had candida

> * we don’t know that your dietary changes affected your candida
>   status

> * and, in fact, we don’t know why you got better.

>Now, if the changes suggested by Crook’s book work for you, fine.  But
>all we know is that they worked for you.  We don’t know why, and we
>don’t know that they’d work for anyone else.

>  – David Wright, Hitachi Computer Products (America), Inc.  Waltham, MA
>     wri…@hi.com  ::  These are my opinions, not necessarily Hitachi’s,
>     but you’re free to disagree, you poor deluded creature

The individual who followed Dr. Crook’s nutritional guidelines has my
applause and support!  If more people would take responsibility for their
own health by applying sound nutritional principles there would be a lot
fewer tragic medical nightmares.  I won’t tell you my story… it would
take too long.  But suffice it to say that if we knew 20 years ago what
we know now about nutrition and natural health remedies, my husband would
not have gone through 20+ years of excruciating suffering with a
devastating chronic illness.  There are long-term irreversible
consequences due to medications and surgeries that he has to live with
for the rest of his life.  So, those of you out there who think you know
it all, you don’t.  Have a little more empathy for those of us who are
willing to try safe, albeit unproven, alternatives to the often times
very drastic solutions the conventional medical world has to offer.  And
don’t be so quick to knit-pick and find fault with those of us who share
our stories.  Some of us are just common folk and we might not labor over
every word or present our information with such technical precision so
that others can’t find fault with something we say.  Have a heart!!

ms <mstoh…@iastate.edu> writes:
> So, those of you out there who think you know
> it all, you don’t.  Have a little more empathy for those of us who are
> willing to try safe, albeit unproven, alternatives to the often times
> very drastic solutions the conventional medical world has to offer.  And
> don’t be so quick to knit-pick and find fault with those of us who share
> our stories.

Well said.  I have also had experiences with medical conditions which
the Candida program has helped greatly.  I am glad that there are
maverick MD around who are willing to question the conventional
"wisdom".

Jay.C…@Dartmouth.edu

Jay.A.C…@dartmouth.edu

Chiropractors like to give nutritional advice.  It helps to compensate
for the fact that they’re not allowed to prescribe drugs.

- Hide quoted text — Show quoted text -

> As far as "dollars and cents" are concerned,
>I spent $30.00 on the chiropractic, $10.00 on the book, and
>have spent about $100 on supplements over the past four years.  
> After a few weeks on the diet, my numerous symptoms began to
>fade and disappear.  Contrast this to many thousands of dollars
>spent on conventional medical doctors who were completely
>unable to help me or to discover the cause of my health
>problems, and to hundreds of dollars spent on prescribed drugs,
>which did nothing but make me sicker and poorer.  I have not
>been following your discussion from the beginning, but I am
>curious to know why you are so hostile towards those who are
>willing to entertain that candida may be a cause of many
>otherwise inexplicable health problems.  Even though a reliable
>test has not yet been established, if one can improve their
>health by following the recommended regimen when nothing else
>has been successful, then it makes sense to give this route a
>try. If I had not, I would probably not be here today.

Nobody here is sorry that your health improved.  At least I think not.

However, let’s look at the facts, as supplied by you.

1)  You had health problems.  You don’t say what they were.

2)  Various prescription drugs did not help.

3)  Dr. Crook’s book seemed to describe your symptoms.

4)  You decided to follow the recommendations in the book.

5)  Your health improved.

So far, this is ALL we know.

 * we don’t know that you had candida

 * we don’t know that your dietary changes affected your candida
   status

 * and, in fact, we don’t know why you got better.

Now, if the changes suggested by Crook’s book work for you, fine.  But
all we know is that they worked for you.  We don’t know why, and we
don’t know that they’d work for anyone else.

  — David Wright, Hitachi Computer Products (America), Inc.  Waltham, MA
     wri…@hi.com  ::  These are my opinions, not necessarily Hitachi’s,
     but you’re free to disagree, you poor deluded creature

>JB.

Dear JB,
I am one of those patients you so condescendingly refer to.  It
was suggested to me by a chiropractor that I may want to read
"The Yeast Connection" and to follow the diet since I was
experiencing many of the nearly debilitating symptoms which are
considered by Dr. Crook to be indicative of systemic or chronic
yeast infection.  As far as "dollars and cents" are concerned,
I spent $30.00 on the chiropractic, $10.00 on the book, and
have spent about $100 on supplements over the past four years.  
 After a few weeks on the diet, my numerous symptoms began to
fade and disappear.  Contrast this to many thousands of dollars
spent on conventional medical doctors who were completely
unable to help me or to discover the cause of my health
problems, and to hundreds of dollars spent on prescribed drugs,
which did nothing but make me sicker and poorer.  I have not
been following your discussion from the beginning, but I am
curious to know why you are so hostile towards those who are
willing to entertain that candida may be a cause of many
otherwise inexplicable health problems.  Even though a reliable
test has not yet been established, if one can improve their
health by following the recommended regimen when nothing else
has been successful, then it makes sense to give this route a
try. If I had not, I would probably not be here today.

Cindi Sullens    

richard sullens
inter…@pipeline.com
compuserve 71732,463