Episode 2: Candida, Sacchromyces, and Your Body’s Many Fungal Strains
In part 2 of the series, Dr. Mahmoud Ghannoum continues laying the microbiome groundwork as we discuss fungus and Candida, his favorite microorganism. If you missed part 1 about what the microbiome is and why it’s so important, go back and give it a listen.
There’s a fungus among us...actually, a lot of fungus. While most people are familiar with fungus because of mushrooms, the world of fungi is far wider and more wonderful than these culinary delights. There’s a common belief that fungi is a plant, but it’s not. In fact, it’s more closely related to humans than it is to broccoli, poinsettias or grass.
How is that possible? On this episode, Dr. Ghannoum is back in the studio explaining how fungus plays a huge role in our lives (bread, beer, and penicillin, anyone?) and our microbiomes.
We talk about why fungus was ignored for so long in the research and how the claims against Candida may be overblown. We also chat about who’s most susceptible for fungal infections and how Dr. Ghannoum’s persistence blew the doors open for fungal science to expand.
By the end of the show, you’ll have a good handle on how to keep your fungal colonies in check and what the next great frontier looks like in terms of how bacteria and fungus work together to cause harmony or create havoc.
Here’s what you’ll learn:
- The impact of Fungi on our health and wellness [2:28]
- Fungus in our microbiome [6:09]
- Impact of antibiotics [9:16]
- The effect of drugs [11:59]
- Let’s talk about Candida [14:54]
Andrea Wien: I'm functional nutritionist, Andrea Wien and this is the Microbiome Report powered by BIOHM Health. In the first episode of this three part series, we took a look at the microbiome to understand what it is, where it lives and why we should care. In this episode, I'm joined again in the studio by Dr. Mahmoud Ghannoum, the director of the Center for Medical Mycology at Case Western Reserve University and University Hospitals, Cleveland Medical Center. We dissect the wide world of fungus, and I learned that our fungi guy friends are more similar to us humans than they are to plants. By the end of this episode, you'll have a new appreciation for all things, fungus, and you may even be able to give the most famous fungi of the moment. That'd be candida, a bit of a break. So happy to have Dr. Ghannoum back in the studio today, talking to us about his favorite topic, fungus. So thank you for being here.
Dr. Mahmoud Ghannoum: Thank you very much, it's my pleasure always.
Andrea Wien: So let's talk about what is fungi, because I think a lot of people think they know what bacteria is, makes us sick, helps our microbiome. Not as many people know exactly what is fungus, is it the mushrooms that we eat? Is it something different?
Dr. Mahmoud Ghannoum: Well, definitely mushrooms is one of organisms which are fungus. So yes, everybody should know fungus because we all eat mushrooms, even so some people may not like it, but they know it. Now fungi for very long time, people used to think it is like a plant most probably because of the mushroom. But in fact, it is different from plants. You have, for example, bacteria is one group and then fungi is another, both of them are microorganisms or microbes, but they differ. Okay. In fact, fungi is very close to us. Like as we have similar structure of cells like fungus, and that's why a lot of the time when we're trying to see how we can control fungus using, let's say antifungal agent or a drug that kill fungus, it's difficult because they are like us. So you can think about fungi as more close to us than bacteria.
Andrea Wien: How so? That doesn't even make sense to me.
Dr. Mahmoud Ghannoum: Well, because listen, I mean, when you look at the structure of the fungal cell, it has a nucleus. Where as bacteria does not have nucleus. We as a human, we have a nucleus. So that's why we are closer to it.
Andrea Wien: Okay. Okay. What is the overall impact on our health and wellness in terms of fungi? How does it affect those areas?
Dr. Mahmoud Ghannoum: So let me tell you first like about fungi again, and then we'll come into the health. Fungi, it's not only the mushroom, for example, fungi, we have good fungus and we have some fungus, which is cause problems. Good fungus, the best example is the one like penicillium, which is the fungus that produce penicillin the antibiotic, which really changed the way we manage infections. So this is a good fungus. You have another good fungus, for example, for making bread or brewing the beer we drink without fungus will be in a bit of a [crosstalk 00:03:12].
Andrea Wien: Okay. Now I'm seeing how we're connecting the beer and the... I get it all now. Okay.
Dr. Mahmoud Ghannoum: So, and that's why we have a fungus called Saccharomyces, which makes beer, we use it to ferment bread as well as beer. So that's the good side of the fungus, but there are some other fungus which could cause problems. Now, as we mentioned before, in the previous recording, some of these organisms, the fungus, the bad one in general, they don't cause a lot of trouble. The only time they start to cause these become pathogenic or virulent, the only time they cause problem is when our body change, I call fungus always the organism of the immunocompromised. It cause infection. If your immunity is down or if you are using some drugs, which can to encourage it, to grow and overgrow. So this is the two types of fungus, which we can think about.
Andrea Wien: So when someone gets something like Tinea Versicolor on their skin, which is a fungus that causes your skin to look splotchy, almost like vitiligo or someone has athlete's foot. And that's a fungus that's causing that. You would say that there's a immunocompromised state, that that person is in. And that's why that fungus is able to take over and something like the skin.
Dr. Mahmoud Ghannoum: In the skin that's exactly. Sometimes it's genetics. Some people are more prone to it, but also in the skin, what happens like I can give you an example. We have fungal infections in the toes. You know, some people have in their toes or athlete's foot, or you have it in the nail. Now we will have a fungal infection in the nail in people who have athlete's foot. It seems you are predisposing you to this infection. In a way you could be due to trauma for example, you may have that you would give the opportunity for the fungus to cause infection in your foot or where you have blisters and this sort of thing. And that's why we have it. We actually did this study a few years ago, which we published with the CDC, where we showed that people who are more than 54 years.
So for me, I am really too old for it. If you are more than for 54 years, you have higher risk of an infection. Males, believe it or not. If you are a male, you are more likely to have fungal infection in your nail. Okay?
Andrea Wien: It's all that beer they're drinking.
Dr. Mahmoud Ghannoum: And also what we found, if you have trauma, we all let's say, if you are playing soccer or playing any sport and you hit the nail and then this will open the way for fungus to come and cause infection. So you can see there is multifactorial reasons for having an infection, but in general, it doesn't cause a problem.
Andrea Wien: Now let's talk about the gut because you named the microbiome and you were really one of the main researchers who started discovering that we have fungus in our microbiomes. So in terms of the gut microbiome, why was fungus ignored for so long? Certainly researchers had to have seen it,
Dr. Mahmoud Ghannoum: You know, in general, with respect to fungus and including in the gut, people did not. When they started to look at the microbiome, they focused only on bacteria and people sometimes don't think fungus. So a lot of researchers just ignore that. And that's why in 2010, I wrote an article where I said there is, you know, we need to remember in our body, there is both bacteria and fungi. And I gave an example, if a woman take Tetracycline, an antibiotic, guess what happens? You kill the bacteria, but at the same time, you start to developing thrush. So because of this, I thought it's really important to look in the same samples, what bacteria and what fungus in there. And for number of years, people did not listen. So I, you know me, I don't give up. So I 2016, I wrote another article in the Scientist where I brought to attention the fact that people are not looking at fungus, and that's when really people start to listen to what we are talking about.
And now I'm, I'm glad to say, not only my group works on fungus and bacteria in the gut, as well as in other parts of the body, such as the skin, we are now making inroads to understanding not only the bacteria, but the fungus. And I hope more and more people will look into this because these organisms living in the gut, they work together in our skin. They work together. And we really, if we want to have better ways of managing these issues, we have, we need to understand both bacteria and fungus.
Andrea Wien: Yeah, we need to know who's there. Right?
Dr. Mahmoud Ghannoum: Exactly, exactly.
Andrea Wien: So when we think about that, you mentioned saccharomyces, you mentioned a few other strains. What are really the major fungal strains that we're talking about when we're talking about the different microbiomes?
Dr. Mahmoud Ghannoum: So when we looked in the mouth, for example, we found 90 different organisms in fact hundred and one different species of fungus were present in the mouth. But when you look at some of these organisms are transient, because sometimes as I mentioned, you eat mushrooms or you eat cheese that have fungus, you can detect it. We found 15 different organisms, what we call core microbiome and that made of candida, fusarium, penicillium, cryptococcus, and I can go on and counting them. But at least we know from our studies that there is at least 15 different major fungal organisms in our mouth.
Andrea Wien: So they're the ones that are really there. They're setting up shop, they have their home and the other ones are just passing through saying, hello.
Dr. Mahmoud Ghannoum: Exactly. That's what we call transient.
Andrea Wien: You mentioned briefly about antibiotics specifically Tetracycline, killing the bacteria, and then allowing the fungus to take over. Can you talk a little bit more about how antibiotics and medicine in general can really affect the fungal stability?
Dr. Mahmoud Ghannoum: Yeah. I mean the most studied obviously is the antibiotics. It's very simple really. The idea is that when you take an antibiotic, you are killing not only the infection that causing issues to you, you are also killing the good organisms such as the Lactobacillus. And because of this, when you get rid of the Lactobacillus, then candida and other bad organisms start to grow. Okay? So in a way it's very important. So the antibiotic basically, by getting rid of our guards, we are allowing fungus to grow, but then on other drugs as well. Like for example, people who take steroids, anti inflammatory drugs, these also can change their balance because they affect the hormones and they affect different bodies, different aspects of our body. And that allows the steroid to increase. In fact, you will laugh at this because I've been saying like, I studied fungus for 42 years, my first paper where my mentor, who I was studying with in England, he gave me a paper.
He said Mahmoud this is your PhD. I say, Oh my God, I looked at it. And it is about people who using steroids, they are starting to have more fungal infections. So steroids is another group of drugs that can affect the microbiota and encourage the growth of fungi. But in general, you can look at other organisms as well, like pesticides. Pesticides, what's happening in Europe, in particular, it started. We use these pesticides to control the plant diseases so that our crops will be healthy. And they are using some of these pesticides that can kill the fungus and the fungus they are smart guys like the bacteria, they become resistant to these organisms. And now we are starting to see that even organisms in our body, they are changed because of the pesticides as well.
Andrea Wien: I think too, I read an article about non-steroid anti-inflammatories like Tylenol and Aleve and Aspirin, having a similar effect of being able to change the gut microbiota. Is that something that you've seen as well?
Dr. Mahmoud Ghannoum: You know, I attended a lecture in Barcelona where they talked about different therapeutic agents including their nonsteroidal, anti inflammatory agents. And really we see a lot of drugs that can affect the microbiota. Like there is a studies on the reflux people take everyday all of these...
Andrea Wien: The antacids.
Dr. Mahmoud Ghannoum: Anti acids, and they have been shown to affect the microbiota in general and they could also affect the fungi as well.
Andrea Wien: Well that would make a lot of sense to me because if you're killing or you're turning off the acid production, it's not able to kill some of the microorganisms that you could be ingesting and then they're passing through and potentially wreaking havoc further down in the digestive tract.
Dr. Mahmoud Ghannoum: Absolutely.
Andrea Wien: So going back to putting pesticides on our food, it made me think a bit about soil being immunocompromised. You know, we're putting all of these chemicals down, there's obviously bacteria and fungi in the soils. And so if we're killing those, it makes me think a little bit about what we were talking about with the HIV patients and the immunocompromised systems. The soil could be immunocompromised, and then we're not getting those same benefits from the earth.
Dr. Mahmoud Ghannoum: Definitely, definitely this is the case. And as I told you, the best example was really in Belgium, where they start to look at the soil and the different organisms, and they start to see a change in the microbiota in soils, which are treated with these pesticides. You know, the interesting thing also for a number of years, it was in Europe. And now suddenly we have in Texas, they studied some soils and some environmental samples, and guess what they are seeing that these organisms are there. So definitely using all these chemicals, indiscriminately is going to affect the micro flora in the soil, which by extension, as you know, eventually it will reach us as a human being.
Andrea Wien: So you mentioned antibiotics, really throwing this whole balance off, people take antifungals too. So does it work the other way? Where if we're killing off the fungal communities, then the pathogenic bacteria could potentially take over?
Dr. Mahmoud Ghannoum: You know, this is very good question. I have not thought about it a lot, but I can tell you by studying the recent studies which we did in the gut, where we are showing that there is fungi and bacteria, they come and work together and they make biofilms. And by disrupting this biofilm, especially if we disrupt, let's say a healthy biofilm, then by killing yeast, for example, the saccharomyces then that's not good. It's going to affect our body. But in general, the antifungals don't have as much impact in our microbiota as the antibacterial.
Andrea Wien: So if someone does have an overabundance of a fungal strain in their gut, aside from taking an antifungal, how can you really keep that in check?
Dr. Mahmoud Ghannoum: Number one, there are different ways you can do that. Number one is you can use a probiotic that has good fungi, where it can replace it. Like for example, Saccharomyces Boulardii is a good fungus. You can also change the diet. By changing the diet for example, there are good studies to show you, if you have high carbohydrate diet, you are going to encourage the growth of fungi, the bad ones, especially Candida. So in this case, if you use a low carb diet, not a zero diet carb, no just low carb diet. It's going to help you to really re-balance, the gut. And also you are not giving as much nutrition to the fungi to grow. So you can balance it with diet as well as, as we mentioned, trying to control using probiotic nutrition supplements, for example.
Andrea Wien: And when you're talking about low carb, you're not talking about the carbs that come in, broccoli and spinach. You're more so talking about the starchier carbs or the bakery items, the croissant someone had yesterday for breakfast.
Dr. Mahmoud Ghannoum: Exactly. Yes, exactly. Exactly.
Andrea Wien: So now that you brought up Candida, let's just talk about it. I know it's your favorite, your favorite organism, but it seems like everyone thinks that they have Candida overgrowth right now. It's in every blog, the wellness community is going crazy about it. People get their gut reports back and get upset that they don't see Candida there because they're just certain that they have it. So how common is it really?
Dr. Mahmoud Ghannoum: You know, as I mentioned, if you look at people in general and we did study people who are healthy and we compare them, you can find Candida and about 50 to 70% of people. But this does not mean that Candida is causing issue. Because as I mentioned, Candida is present in our body as a normal colonizer. It lives there, it's causing no problems. The only time it starts to cause problems is when it is overgrown. If it's overgrown, then it's going to start to take over and also start to collaborate with the bacteria as we showed in our published study and caused invasion to and the breaking down of the lining of the stomach. But really there is a lot of hype about Candida. It does not every sort of a GI problem. Every what you call yeast syndrome, every issue you have, the lethargy, fogginess, and they blame it on Candida.
This is not true. These studies are not supported. I think we need to put into perspective. Candida could be there as a normal, even if you find it, you don't have to go really berserk and crazy. No, as long as it is present at a low level or low abundance, as we call it in the microbiome, then it should be fine. If it is high up on that, the good news is we can control it as well. There are very good drugs now to control that also we can control it with diet. So to me, it's very important to put everything in perspective. And these days, as you said, you go into blogs and people claim things, and there is no evidence to support them.
Andrea Wien: Dr. Ghannoum, always a pleasure. Thank you so much for coming in today. We will talk to you soon.
Dr. Mahmoud Ghannoum: Thank you very much. It's a great pleasure to talk to you.
Andrea Wien: Thanks so much for listening to part two of our three part series setting the stage of the microbiome. If you enjoyed the show and didn't listen to our episode last week, make sure you go back and check it out. We'll be back next week with a new episode.
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