The Problem with Intestinal Yeast and Lyme, Bartonella or Babesia
Too many yeast in the intestines (yeast overgrowth) is a common problem that occurs in those with chronic Lyme disease, Bartonella, and Babesia. This problem occurs during a care regimen, or prior to beginning care. Prescription antibiotics, and to a much lesser degree herbal antibiotics, lead to intestinal yeast excess. Immune suppression prior to starting antibiotics can also cause yeast overgrowth.
The Problem. 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, Bartonella, and Babesia 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 several natural and prescription medicine options to address yeast and to prevent future problems with yeast overgrowth. These options have three basic steps using a feed, seed and weed approach. For best results take the feed, seed and weed steps simultaneously and throughout a care regimen.
- Feed your intestinal microbiome to promote gut health;
- Seed your intestinal microbiome with the right probiotic based on your intestinal health; and
- Weed your intestinal microbiome to decrease your intestinal yeast germ load.
How to Diagnose Yeast Overgrowth in Lyme Disease
For information about diagnosing too many yeast, read A Silent Problem—Is It Yeast?
Step 1. Feed your intestinal microbiome with polyphenols and prebiotic fibers
It is important to do the actions in Step 1. throughout your herbal or prescription antibiotic care regimen with or without intestinal yeast overgrowth.
Option 1. Use Supplements
- Polyphenol 2 capsules one time a day.
- Prebiotic non-digestible sugars 1 to 2 pills 3 times a day.
Option 2. Eat a Plant-forward Whole Food Diet
- Include polyphenols and prebiotic plant fibers in your diet by eating a whole food diet rich in colorful berries and fruits, vegetables, beans, legumes, nuts and seeds. Aim for at least 30 grams of plant-based fiber a day which you can track using an app like MyFitnessPal or by having at least 5 servings a day of the various foods types listed above. In choosing a whole-foods plant-forward diet, it is ok to use animal proteins or plant-based proteins for your protein source.
Here are some resources to help you eat a plant-forward whole food diet.
- For a paleo-based diet rich in plant foods and low-inflammatory animal proteins see The Best Brain, Inflammation, Pain, Energy & Detox Diet Ever.
- Mediterranean diets are also a good choice.
- If you are new to plant-based eating, consider working with the Whole30 diet program to get started.
An elimination diet is another diet to consider starting if you are very reactive to several foods. For detailed information, see Elimination Diet to Find Food Problems.
Step 2. Seed your intestinal microbiome with the right probiotic based on your intestinal health
Option 1. No Leaky Gut Syndrome Symptoms
If you do not have any intestinal symptoms of leaky gut, this option is for you.
Symptoms suggesting leaky gut can include intestinal gassines, bloating, or cramping, or multiple food sensitivities. The general probiotics I recommend here support and promote the health and growth of most healthy intestinal bacteria.
- Spore Forming Probiotic (Baccillus) 1 to 2 pills 1 time a day.
Comment. In my experience, probiotic supplement products deliver more probiotics than fermented food sources. I chose a spore-forming probiotic because they are easier to use as they do not require refrigeration. They also do a great job of microbiome rehab and may work even when a person is on antibiotics.
Substitution Consideration. If you have diabetes or are overweight, consider substituting Akermansia mucinphila for the Bacillus spp spore forming probiotic. Akkermansia may raise GLP-1 leading to weight loss and better sugar control. It also supports other intestinal microbiome bacteria like Bacillus spp. Its major drawback is that it is better refrigerated.
- Akkermansia muciniphila 1 or 2 pills one time a day instead of Bacillus spp.
Option 2. Leaky Gut Symptoms with or without Intestinal Yeast Overgrowth
If you have intestinal symptoms, this option is for you.
If you have intestinal symptoms like gassiness, bloating, or cramping; or multiple food sensitivities, work to rebuild the intestinal lining and mucin layers while promoting the health and growth of good intestinal bacteria. Use this probiotic option regardless of whether you are addressing yeast or bacterial intestinal dysbiosis with targeted antimicrobials.
- Akermmansia + Butyrate Producers 1 pill 2 times a day. (Butyrate producing probiotics can include Bifidobacterium, Anaerobutyricum hallii, Clostridium beijerinckii, and Clostridium butyricum.)
Comment. With leaky gut there is injury to the mucin layer of the intestines that covers intestinal cells. Additionally, the intestinal lining develops gaps between the cells. Akkermansia builds the mucin layer. Bifidobacterium, Anaerobutyricum hallii, Clostridium beijerinckii, and Clostridium butyricum produce butyrate which is the leading fuel source for intestinal cells. Mucin in combination with butyrate helps heal the gaps between the intestinal cells.
More Information
Regulating the intestinal microbiome is complex. For more information and additional probiotic choices see Your Guide to a Healthy Intestinal Microbiome—Even on Antibiotics.
Step 3. Weed your intestinal microbiome to decrease your intestinal yeast germ load
A. Weeding Options for Active Intestinal Yeast Overgrowth
Use these weeding options in addition to the Step 1. Feed and Step 2. Seed options above.
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. The following is a sample regimen. Note: I include nystatin or the herbal combination mixture to prevent yeast resistance developing to the fluconazole (or another azole).
- Fluconazole 200 mg 1 pill daily for 30 days;
- Nystatin 500,000 IU 2 pills 2 times a day ongoing while on herbal or prescription antibiotics.—OR—
- Anti-Yeast Herbal Combination 1 pill 1 time a day and as you can increase slowly up to 2 pills two times a day or 1 drop two times a day working slowly to 20 drops 2 times a day. (Ingredients in herbal combinations can include caprylic acid, garlic, rosemary oil, oregano oil, cinnamon bark, clove bud, pau d’arco bark, berberine, and stillingia sylvatica.)
Alternatives to The Azoles
Alternatives to an azole-based treatment include a support herbal combination mixture or a compounded prescription medicine called amphotericin B.
Herbal Combination Mixture
- Anti-Yeast Herbal Combination 1 pill 1 time a day and as you can increase slowly up to 2 pills two times a day or 1 drop two times a day working slowly to 20 drops 2 times a day. (Ingredients in herbal combinations can include caprylic acid, garlic, rosemary oil, oregano oil, cinnamon bark, clove bud, pau d’arco bark, berberine, and stillingia sylvatica.)
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.
- Amphotericin B 200 mg pill 3 times a day for 2 months.; and
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
- Amphotericin B 200 mg 3 times a day for 2 months
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
- Itraconazole 100 mg 2 pills 1 time a day for 30 days; and
- Nystatin 500,000 IU 2 pills 2 times a day ongoing while on herbal or prescription antibiotics.—OR—
- Anti-Yeast Herbal Combination 1 pill 1 time a day and as you can increase slowly up to 2 pills two times a day or 1 drop two times a day working slowly to 20 drops 2 times a day. (Ingredients in herbal combinations can include caprylic acid, garlic, rosemary oil, oregano oil, cinnamon bark, clove bud, pau d’arco bark, berberine, and stillingia sylvatica.)
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
- Terbinafine 250 mg (Lamisil) 1 pill a day for 2 full months; and
- Nystatin 500,000 IU 2 pills 2 times a day ongoing while on herbal or prescription antibiotics.—OR—
- Anti-Yeast Herbal Combination 1 pill 1 time a day and as you can increase slowly up to 2 pills two times a day or 1 drop two times a day working slowly to 20 drops 2 times a day. (Ingredients in herbal combinations can include caprylic acid, garlic, rosemary oil, oregano oil, cinnamon bark, clove bud, pau d’arco bark, berberine, and stillingia sylvatica.)
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.
Experimental Option
- Lufenuron 3 mg for 3 days in a row of each 14 days. Repeat this cycle four times for a complete regimen.
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 option. Human studies have not been done, but it does appear safe in animal studies. See Lufenuron for Yeast for more information about this option and where to purchase it.
Considerations for Choosing a Yeast Resistance Option
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.
B. Weeding Options to Prevent Intestinal Yeast Overgrowth
Use these weeding options in addition to Step 1. Feed and Step 2. Seed options above.
- Nystatin 500,000 IU 2 pills 2 times a day ongoing while on herbal or prescription antibiotics.—OR—
- Anti-Yeast Herbal Combination 1 pill 1 time a day and as you can increase slowly up to 2 pills two times a day or 1 drop two times a day working slowly to 20 drops 2 times a day. (Ingredients in herbal combinations can include caprylic acid, garlic, rosemary oil, oregano oil, cinnamon bark, clove bud, pau d’arco bark, berberine, and stillingia sylvatica.)
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