Kills & Prevents Yeast: A Brief Guide

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How to treat yeast in Lyme disease Image from Marty Ross MD

Updated August 23, 2022

Key updates include:

  • intestinal yeast overgrowth prevention strategies
  • improved readability of the various treatment options
  • comments on why I do not recommend voriconazole
  • improved diet recommendations
  • why, when, and how to incorporate soluble fiber

Marty Ross MD

The Problem with Intestinal Yeast and Lyme Treatment

Too many yeast in the intestines (yeast overgrowth) is a common problem that occurs in those with chronic Lyme disease. This problem occurs during treatment, or prior to beginning treatment. Prescription antibiotics, and to a much lesser degree herbal antibiotics, used to treat Lyme lead to intestinal yeast excess. Immune suppression prior to starting antibiotics can also cause yeast overgrowth.

Yeast overgrowth can result in an ongoing systemic allergic reaction to the yeast that can suppress the immune system. Yeast overgrowth also leads to inflammatory cytokine excess that causes many of the Lyme disease symptoms and pain. Food allergies and sensitivities are the result of yeast overgrowth, too. Learn more about cytokines in Control Cytokines: A Guide to Fix Lyme Symptoms & The Immune System.

In this article, I lay out a number of natural and prescription medicine options to treat yeast and to prevent future problems with yeast overgrowth.

Marty Ross MD Discusses Treatments for Intestinal Yeast

 
 
 
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How to Diagnose Yeast Overgrowth in Lyme Disease

For information about diagnosing too many yeast, read A Silent Problem. Do You Have Yeast?

Yeast Treatment in Lyme Disease

The Azoles Plus Nystatin

The most common and effective prescription medicines used to treat yeast are from the azole family of antimicrobials. These include fluconazole (Diflucan), ketoconazole, and itraconazole (Sporanox).

Note: The newest and strongest member of the azole family is voriconazole. However, it is very potent and has the potential for numerous side effects. Due to its strength and ability to kill a broad range of yeast and mold, it can cause very severe Herxheimer reactions. For this reason, I do not recommend using voriconazole. 

The other common prescription anti-yeast medication is nystatin, but is much weaker than the azoles. Here is a sample treatment. Note, I include nystatin or the herbal combination mixture to prevent yeast resistance developing to the fluconazole (or other azole).

  • fluconazole 200 mg 1 pill daily for 30 days PLUS
  • nystatin 500,000 IU 2 pills 2 times a day ongoing while on herbal or prescription antibiotics. A person can replace nystatin with an herbal combination mixture 2 pills 2 times a day. (Common herbs found individually or mixed together that promote yeast removal include: Pau D'arco, caprylic acid, rosemary oil, thyme oil, garlic, and grapefruit seed extract. Products I recommend which include some of these herbs include: CapriPlus by Karuna and Phytostan by Integrative Therapeutics.) PLUS
  • probiotics 2 to 4 pills 1 time a day at least two to four hours away from herbal or prescription antibiotics. A high-quality probiotic promotes healthy intestines. See Probiotic Strategies in Lyme Disease Treatment for high quality probiotics I recommend.

To summarize, a treatment using an azole includes:

  • a probiotic plus
  • fluconazole, ketoconazole, or itraconazole, plus
  • nystatin or an herbal combination mixture.

Alternatives to The Azoles

Alternatives to an azole-based treatment include an herbal combination mixture or a compounded prescription medicine called amphotericin B.

Herbal Combination Mixture

  • herbal combination mixture 2 pills 2 times a day. (Common herbs found individually or mixed together that promote yeast removal include: Pau D'arco, caprylic acid, rosemary oil, thyme oil, garlic, and grapefruit seed extract. Products I recommend which include some of these herbs include: CapriPlus by Karuna and Phytostan by Integrative Therapeutics.)
  • probiotic 2 to 4 pills 1 time a day. See Probiotic Strategies in Lyme Disease Treatment for high quality probiotics I recommend.

This herbal approach will work but may take three months. For bad yeast infections, you may even need to stop your prescription antibiotics while trying this approach.

Amphotericin B

Amphotericin B is only manufactured in an IV formulation. However, for intestinal yeast infections, a compounding pharmacist must mix it for oral use. Otherwise, it is barely absorbed into the bloodstream and thus has no systemic toxicities. I am pointing this out because in an IV form, it is terribly toxic to the organs of the body but it is completely safe in oral form.

You will need a prescription for amphotericin B sent to a compounding pharmacy. For a really severe yeast infection you may even need to stop your prescription antibiotics.

Yeast Resistance

Unfortunately, yeast is becoming resistant to fluconazole. When this happens, there are four other options.

Option One

This option is effective 95 percent of the time. A two month supply of amphotericin B approaches $400.00.

Option Two

  • itraconazole 100 mg 2 pills 1 time a day for 30 days PLUS
  • nystatin 500,000 IU 2 pills 2 times a day ongoing while on herbal or prescription antibiotics. A person can replace nystatin with an herbal combination mixture 2 pills 2 times a day. (Common herbs found individually or mixed together that promote yeast removal include: Pau D'arco, caprylic acid, rosemary oil, thyme oil, garlic, and grapefruit seed extract. Products I recommend which include some of these herbs include: CapriPlus by Karuna and Phytostan by Integrative Therapeutics.) PLUS
  • probiotic 2 to 4 pills one time a day. See Probiotic Strategies in Lyme Disease Treatment for high quality probiotics I recommend.

This option is effective about 80 percent of the time when a fluconazole treatment fails. Insurance often will not pay for this option. Itraconazole costs nearly $75 a month using a GoodRX.com coupon.

Option Three

  • terbinafine 250 mg (Lamisil) 1 pill a day for 2 full months PLUS
  • nystatin 500,000 IU 2 pills 2 times a day ongoing while on herbal or prescription antibiotics. A person can replace nystatin with an herbal combination mixture 2 pills 2 times a day. (Common herbs found individually or mixed together that promote yeast removal include: Pau D'arco, caprylic acid, rosemary oil, thyme oil, garlic, and grapefruit seed extract. Products I recommend which include some of these herbs include: CapriPlus by Karuna and Phytostan by Integrative Therapeutics.) PLUS
  • probiotic 2 to 4 pills one time a day. See Probiotic Strategies in Lyme Disease Treatment for high quality probiotics I recommend.

This option works about 80 percent of the time. Terbinafine is approved for the treatment of fungus infections. It is in an entirely different family than the azoles. In a generic form, it costs around $50 for a one-month treatment.

Experimental Option

  • lufenuron 3 gm for 3 days in a row of each 14 days. Repeat this cycle four times for a complete treatment.
  • probiotic 2 to 4 pills one time a day. See Probiotic Strategies in Lyme Disease Treatment for high quality probiotics I recommend.

Lufenuron is a veterinary medicine that may block the production of chitin found in the coverings of yeast. Chitin is a hard-fibrous substance found in insects and yeast. It is not found in humans. This option works over two months 80 percent of the time. Be aware that this is an experimental treatment. Human studies have not been done, but it does appear safe in animal studies. See Lufenuron. An Experimental Yeast Treatment for more information about this medicine and where to purchase it.

Option Selection Considerations

Often, in yeast resistance I also advise my patients to stop other herbal and prescription antibiotics. Because of costs, I usually use itraconazole or terbinafine first, then amphotericin B. I save lufenuron as a last resort.

In yeast resistance, based on my clinical experience, amphotericin B taken for two months works 95 percent of the time, itraconazole taken for 30 days works 80 percent of the time, terbinafine taken for two months works 80 percent of the time, and lufenuron taken for two months works 80 percent of the time.

Anti-Yeast Diets in Lyme Disease

While treating yeast, it is essential to limit simple sugars and juices. Simple sugars are those items which have a lot of sugar added like coke, candy, cookies, cake, and ice cream. The idea is to limit simple sugars to starve yeast.

For those with a great deal of yeast treatment resistance or who get yeast frequently on herbal and prescription antibiotics, a plant-forward paleo diet which is low in sugars and simple carbohydrates helps. Sugars and simple carbs can feed yeast - so limiting them may help. Read more about the plant-forward paleo diet in The Best Brain, Inflammation, Pain, Energy, and Detox Diet Ever.

Preventing Recurrent Yeast Infections:
Weed, Seed & Feed

Basic Steps

Throughout Lyme disease treatments with herbal or prescription antibiotics, I suggest using probiotics and either nystatin or an herbal anti-yeast combination (discussed above) to weed and seed the intestines. Nystatin and herbal anti-yeast combinations weed out yeast that try to grow. While the probiotics seed the intestines with healthy bacteria.

  • nystatin 500,000 IU 2 pills 2 times a day ongoing while on herbal or prescription antibiotics. A person can replace nystatin with an herbal combination mixture 2 pills 2 times a day. (Common herbs found individually or mixed together that promote yeast removal include: Pau D'arco, caprylic acid, rosemary oil, thyme oil, garlic, and grapefruit seed extract. Products I recommend which include some of these herbs include: CapriPlus by Karuna and Phytostan by Integrative Therapeutics.) PLUS
  • probiotics 2 to 4 pills 1 time a day at least two to four hours away from herbal or prescription antibiotics. See Probiotic Strategies in Lyme Disease Treatment for high quality probiotics I recommend.
  • limit simple sugar and juices

Bigger Yeast Control & Prevention Steps

Sometimes you have to feed the good bacteria in the intestines so they can keep yeast under control. I recommend adding steps to feed healthy intestinal bacteria when a person has recurrent and difficult to treat intestinal yeast infections.

One of the best food sources for healthy intestinal yeast is soluble fiber. Food sources of low carb (sugar) soluble fiber include avocados, soy nuts, ​oat bran, ​brussels sprouts, ​sweet potato, ​asparagus​ and broccoli. Another option to increase soluble fiber is to take modified citrus pectin powder 1 scoop one or two times a day. This is a supplement.

To summarize - for people who get repeated yeast infections during herbal or prescription antibiotic treatments I recommend:

  • probiotics 2 to 4 pills 1 time a day
  • nystatin 500,000 IU 2 pills 2 times a day or an herbal combination mixture (discussed above) 2 pills 2 times a day
  • soluble fiber food or modified citrus pectin powder 1 scoop 1 to 2 times a day.
  • plant-forward paleo diet that limits sugars and simple carbohydrates. Read more about the plant-forward paleo diet in The Best Brain, Inflammation, Pain, Energy, and Detox Diet Ever.

Disclaimer

The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.

References

View Citations

  1. Bellmann R, Smuszkiewicz P. Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients. Infection. 2017;45(6):737–779. doi:10.1007/s15010-017-1042-z. (View)
  2. Ching MS, Raymond K, Bury RW, Mashford ML, Morgan DJ. Absorption of orally administered amphotericin B lozenges. Br J Clin Pharmacol. 1983;16:106–108. (View)
  3. Guan ZW, Yu EZ, Feng Q. Soluble Dietary Fiber, One of the Most Important Nutrients for the Gut Microbiota. Molecules. 2021;26(22):6802. Published 2021 Nov 11. doi:10.3390/molecules26226802 (View)
  4. Kumamoto CA. Inflammation and gastrointestinal Candida colonization. Curr Opin Microbiol. 2011 August;14(4):386-391. doi:10.1016/j.mib.2011.07.015. (View)
  5. Olmstead S, Meiss D, Ralston J. Candida, fungal-type dysbiosis, and chronic disease: exploring the nature of the yeast connection. Townsend Letter. http://townsendletter.com/June2012/candida0612.html. Accessed September 16, 2018.
  6. Ross M. Lufenuron: an experimental yeast treatment. Treat Lyme. https://www.treatlyme.net/guide/lufenuron-an-experimental-yeast-treatment. Accessed August 15, 2018.
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About the Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice. 

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS) and The Institute for Functional Medicine.

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