Updated: 2/2/23
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.
For information about diagnosing too many yeast, read A Silent Problem. Do You Have Yeast?
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. The following is a sample treatment. Note: I include nystatin or the herbal combination mixture to prevent yeast resistance developing to the fluconazole (or another azole).
To summarize, a treatment using an azole includes:
Alternatives to an azole-based treatment include an herbal combination mixture or a compounded prescription medicine called amphotericin B.
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 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.
Unfortunately, yeast is becoming resistant to fluconazole. When this happens, there are four other options.
Option one is effective 95 percent of the time. However, a two-month supply of amphotericin B approaches $400, making it cost-prohibitive for many patients.
Option two is effective about 80 percent of the time when a fluconazole treatment fails. Insurance often will not pay for this option, however. Itraconazole costs nearly $75 a month using a GoodRX.com coupon.
Option three 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.
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 takes two months and is effective 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.
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.
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. Also avoid fruit juicing, but whole fruits and vegetables are fine because they include fiber that decreases the availability of fruit and vegetable sugars. 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 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 The Best Brain, Inflammation, Pain, Energy, and Detox Diet Ever.
Throughout Lyme disease treatments with herbal or prescription antibiotics, I suggest using probiotics and either nystatin or an herbal anti-yeast combination (discussed previously) 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.
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.
To summarize, for people who get repeated yeast infections during herbal or prescription antibiotic treatments, I recommend:
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.
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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