Intestinal Mycosis - An Attempt at Clarification

(Original title: Zur intestinalen Mykose - Versuch einer Klaerung. Der Merkurstab 1998; 51: 65-73. English by A. R. Meuss, FTL, MTA)

Abstract

The multifarious symptomatology of intestinal mycosis is given consideration in natural medicine, though it is not yet possible to say if it is a primary or secondary disorder. There are indications that the presence of Candida albicans in the intestinal flora may play a central role in atopic diseases, psoriasis or seborrheic dermatitis. Many authors militate against calling it pathogenic in this situation, but critics of the syndrome still lack important basic information. Further investigations, especially of the human intestinal flora, will be required.

Fungi show tremendous variety in growth and biological characteristics. By nature they and the diseases associated with them reside in a cool and humid environment. Retarded life forms, they cause retardation in human metabolism and above all in the human warmth organism. They exist where the human being is unable to give his I-organization and above all his warmth and light organism adequate structure in the lower human being. Treatment should therefore aim to strengthen I-activity in the organism and especially in the intestines. Different approaches to the treatment of fungal disease are considered in the light of anthroposophical physiology.

The topical debate

In recent years, a number of authors have referred to intestinal Candida mycosis as a distinct syndrome. Hauss and Hauss, Dumrese and Ehrhardt-Schmelzer, Nolting (5,10,29) and other authors list a whole range of symptoms - alternating diarrhea, flatus, lowered resistance to infection, asthma, eczema, neurodermatitis and psychological symptoms such as lack of drive, depres- sion. Generally speaking Candida albicans is said to be the main culprit.

Can Candida in the intestinal flora be ignored?

Many authors hold the view that the presence of Candida in the intestines of healthy subjects proves that Candida is part of the physiologic intestinal flora.(11, 22, 35, 54) A basic problem is that they do not define "health or indeed consider its nature. Dumrese and Ehrhardt-Schmelzer did at least establish that more than 50% of subjects shown to have Candida albicans in their stools did not feel well. The number of organisms in the stool correlated with the IgG titer for Candida albicans. It will clearly be necessary to give more thought to the definition of health.

Others consider the presence of Candida albicans in the intestines to be a secondary phenomenon when the intestinal milieu is abnormal, e.g. in a case of food intolerance. Many authors refer to the role of intestinal candidiasis in neurodermatitis and urticaria.(3, 24, 25, 26, 36, 37) Others only accept infection with a confirmed physiologic correlate as pathological candidiasis. The absence of confirmed infection parameters does not, however, permit the conclusion that Candida in the intestinal flora is of no significance. Low-grade infections may exist, especially as intestinal mycosis is often symptomless.(14) Some patients actually only realize that they had not been well before once they have been treated. Some authors assume that the absence of inflammatory changes is actually a characteristic of the syndrome. We thus also have to ask how "healthy" individuals with Candida in their flora will feel in a few years' time.

Is Candida albicans a physiologic part of the intestinal flora?

Some authors maintain that Candida albicans is part of the physiologic intestinal flora. Male(24) disputes this, despite the fact that he takes a critical view of the so-called "Candida syndrome" or of it being taken to extremes. In his view, intestinal fungi were much more uncommon before antibiotics came in, and also in primitive peoples. He also speaks of the role played by excess nutrition, especially for infants given formulas instead of mother's milk. Candida is not part of the primary flora developing in the intestines of the newborn.(52) Most authors who consider intestinal Candida mycosis to be patholog- ical believe there to be a connection with a disorder of intestinal homeostasis. Only yeasts and Bifidum bacteria remain when antibiotics reduce the normal bacterial flora.(18) Proliferation of yeasts in the intestine may cause vitamins to be withdrawn.(33) No evidence has thus been brought that Candida albicans is physiologic in the intestine.

The pathogenic Candida factors causing infection are well known - adherence, development of mycelia which may be invasive, enzyme produc- tion.(16, 29, 20) It is not clear, however, when and why saprophytic growth be- comes pathologic. The secretory activity of immunoglobulin A, acting as a mediator between mucosal cells and the inner intestine, is inhibited. It has now been shown that Saccharomyces boulardii yeast can be taken up into the intestine like particles derived from lifeless nature.(6) The situation may be ex- pected to be similar with pathogenic yeasts. Authors agree that fungal infec- tions indicate an area of least resistance in the host. It is also known that small amounts of alcohols are produced in cases of intestinal Candida mycosis. Treatment of intestinal Candida reduces the blood alcohol levels, which are low in any case.(2)

How reliable is current knowledge?

Investigation of the intestinal micro ecology presents considerable methodo- logical problems.(17, 23, 35) This especially applies also to the anaerobic organisms that make up the greater part of the intestinal flora. According to Sonnenbom and Greinwald,(42) a complete analysis of a single individual's intestinal flora done at a specialist institute would take a year! Positive tests for Candida in serum, stools or biopsy material do not correlate with identifiable pathologic conditions,(28) which makes it difficult to evaluate the results. It is also difficult to establish in which part of the intestine the yeasts are growing.(35)

Not much is known about possible symbiosis of yeasts and the human intestinal mucosa.(8) More data are available on therapeutic exhibition of Saccharomyces boulardii.(31) Gibson, Savage, Sonnenbom and Greinwald report on treatment with probiotics.(13, 35, 42)

The clinical relevance of a shift in intestinal organisms is discussed by Chapoy and by Sonnenbom and Greinwald, for example.(7, 42) Abnormalities in the intestinal flora may even induce premature births.(17) This does, how- ever, require fuller investigation. Lack of knowledg is confirmed by Gibson, Stremmel and by Wedding et al.(13, 51) Stremmel(51) does refer to the many in- vestigations stored under "Candida" in databanks, but not on intestinal my- cosis. The Medline Databank has no record of work on mycotoxins and on alcohol production by Candida or yeasts in humans for the years 1991-1996. Thus the effect of yeasts on the mucosal surfaces of the intestine or of en- zymes secreted into the intestinal lumen is not yet known.

There appears to be particular ignorance in the German-speaking areas. Barnert and Wienbeck(4) make no reference to the possibility of dysbac- terial conditions in their review, though its effect appears to have been established.(34, 27)

When is treatment required?

Basically, evidence of yeasts in the intestine or stools does not call for treat- ment. In children in particular this may be a passing phenomenon. Minor infections may quite often be followed by short-term fungal growth in the intestine and this is spontaneously reversible. With food allergies an elimina- tion diet often reduces even massive yeast levels.

In the view of those who consider intestinal mycosis to be a definite syndrome, it involves chronic changes that are difficult to detect. One thus gets a varied picture of absent or mild symptoms and is not sure whether to treat them or not. As fungi tend to be parasitic or saprophytic, their existence goes largely unnoticed. In this respect, too, they behave differently from pathogenic bacteria which as a rule evoke inflammatory defense reactions. Asymptomatic bacteriuria is thus the exception, lack of symptoms with intestinal mycosis the rule.

Many people say after successful treatment that they feel a great deal better. Unidentifiable abdominal problems with fungi found in stool cultures may be an indication for ex iuvantibus treatment. It has to be considered that the detection of fungi in stool smears may also give falsely negative results.

Unless we have a concept of "health", with criteria for "well" or "ill", we can only have opinions. The essential nature of the human being has to be considered as a whole, including soul and spirit, to know if one is dealing with states of health or illness.

The nature of fungi

Simonis(40, 41) has giving a loving botanical description of the fungi as seen by a physician. He calls them retarded life forms that still have an echo of the ancient Saturn period of human and earth evolution and have been unable to relate to the more recent development of the Sun period. In terms of earth evolution they may be considered to belong to the Moon period of earth evolution known as Lemuria. Schoeffler(38) on the other hand considers above all the points of view and way of thinking that have led to the use of antibiotics.

Variety and adaptability

The systematics of fungi cover many categories. Those that play a role in medicine are epidermophytes (Microsporum, Trichophyton), molds (Mucor, Fusarium, cephalospores, Aspergillus, penicillin, cladospores and alternaria), yeasts (blastomycetes) such as Candida, Cryptococcus, Saccharomyces, Trichosporum, Geotrichum, dimorph fungi (Blastomyces, Histoplasma, Coccidioides, Sporothrix), etc. About 180 species have been found to be potentially pathogenic to humans.

Steiner(49) and Simonis(40) referred to fungi as life forms living in the Moon region of the earth. They originate in the element of warmth, like pollen, but then go into the sphere of decay as saprophytes. Their fruiting bodies face the soil and not the light as in higher plants. Rudolf Steiner spoke of the way algae and fungi strongly absorb the astrality of an environment.

Fungi may really be considered to be unicellular. They are eukaryotic and without chlorophyll and therefore have to depend on nutrients in organic matter as a source of energy. On the other hand they are also capable of living under exclusion of light. Fungi can specialize and elongate, sprout and produce hyphae. These may form networks called mycelia. Deriving from a single cell these are called thalli, and if loosely structured colonies. Fungi are able to bud or grow spores to produce conidia, some of them mobile. The spores may be sexual or asexual. Some produce hyphae which then produce mushrooms, as they are commonly called (boletus, fly agaric). The spores are shed in autumn, similar to the pollen of flowering plants.

Fungal spore allergy in autumn is the counter image in time of the seasonal pollen allergy in spring.

Fungi do not produce fruit in the proper sense. Their fruiting element are the asexual spores, as in Aspergillus. Sexual reproduction of spores involves reproduction from the thallus itself with the aid of sexual mechanisms and heterosexual reproduction from different kinds of genetic material. There are fungi where such structures are not known, and also parasexual exchanges between different fungi.

Like fly agaric, many fungi produce surface pigments to face the light. Their actual growth sphere is colorless, however. In this they differ funda- mentally from many higher plants, especially those producing pigments in the root. We might go so far as to say that fungi do the opposite of higher plants when it comes to color. A rose producing red in its leaves seeks to fend off astralization.(43) In pigment-producing fungi, however, the color is part of the astrality they seek to absorb, especially in the case of toadstools and mushrooms. Steiner referred to diphtheria as fungus-like and suggested treating it with cinnabar red,(43) saying that this would tie up the astral body more closely with the ether body. The same applies to medicines made from fly agaric.

In many respects fungi hold a half-way position in nature. Their skeletal matter is the chitin of insects (not in the case of yeasts, however). In their great variety, the alternation of spore, resting stage and shoot form they are close to the algae. Steiner stressed this: "... and so everything that is fungal by nature has a close relationship with the lower animal world, bacteria and similar creatures, and particularly with harmful parasites."(49) Fungi may thus be said to be a kind of chameleon in lower nature, adapting to any given situation.

Fungi and temperatures

Fungi grow at widely differing temperatures. In the human body they thrive at 37 degrees C but especially also at lower temperatures. They are at home in a cool, dark space. But they do not shun humid warmth either. Some specialists among them thrive at quite high environmental temperatures. Spores in particular may be extremely heat resistant whilst they also tolerate very cold temperatures, retaining their germinative power for a long time.

Fungi live in a sphere of warmth that is as yet undifferentiated and in an excess of organic matter. Harking back to earlier stages of earth evolution they have a relationship to the ancient nitrogen and cyanide atmosphere. They do not as a rule generate heat energy in their quite considerable metabolic processes but consume it. They will thus often maintain coolth. Bacterial pro- cesses on the other hand tend to generate heat, as in the spontaneous ignition of hay. Fungi often produce gases and relate more to the watery and airy rather than the heat element. This preference for the watery and airy elements may be the reason why they preferably attack the lungs and intestines in human infections.

Symbiotic union of fungi and the roots of plants produce mycorrhiza, a borderline region between organically structured plant matter and the completely lifeless mineral soil. Such mediation between plant and soil prefigures life, providing excess nitrogen is present.

Substances produced in the mycorrhiza have a deadening effect on the surrounding area. Substances from bacteria inhibit fungal growth and vice versa (e.g. griseofulvin from penicillin). Most modem antibiotics derive largely from fungi, or were originally derived from their substances. Rimpler et al.(32) thus also refer to tumor-active substances in fungi. Steiner's above- mentioned comments(49) may be taken as a spiritual scientific pointer to possible antibiotic actions; which is what Simonis thought.(40, 41) Nystatin has however been isolated from Streptomyces strains capable of producing both antibacterial and antimycotic substances. Toxin production thus seems to be a characteristic of the whole group of fungi, and this no doubt also includes Candida. Nothing of any account has however been published on Candida toxins in recent years.

Relationship to light

Whilst bacteria relate more to warmth, algae differ from fungi in that they show a definite orientation towards light. With their chlorophyll they draw the light down into the water, using it to produce matter in photosynthesis. Binding of iodine by algae also relates to the light.

Fungi do not have these important faculties, being unable to open up to light. They actually prefer the lightless sphere of humus and the roots of higher plants and thrive best under light exclusion. It is only occasionally that they send the fruiting bodies we know as mushrooms and toadstools up into the air from the damp rotting soil. This would seem to be to seek the air, however, rather than the light, so that their spores may spread.

The basic shape of fungi, the spore, is spherical.(40) We thus have a plant in the plant world that consists entirely in a kind of head. Fungi do not develop the leaf sphere which is so much the essence of plant nature. They therefore also do not relate to the rhythmic processes connected with leaf development. Instead they produce a "flower" at ground level, as Steiner put it, also saying that their development is peculiarly astralized.(43) This would explain why they do not relate to the human intestinal system, which is based on plant leaf-type principles, but may become pathogenic in it, similar to the lung.

Steiner also spoke of the soil itself being the basis for fungal life, with fungi not rising above its sphere.⁴⁸ It is different with trees. The powers of the earth make them grow beyond the soil, taking them up into the light. Fungal metabolism thus also relates little to light, unlike that of intestinal bacteria.

Putrefactive bacteria convert matter into bound heat and light energy in their high-energy metabolism. Their heat and light processes integrate in the organism. This is not the case with parasitic fungi. They generally use only partial stages of metabolism, leaving the rest to putrefaction. Their metabo- lism thus does not submit to the principles that guide the human organism, which relates strongly to light.

Relationship to matter

Fungi play an important role in dealing with dying matter in the soil. They show a preference for residues from living organisms that contain nitrogen, and thus facilitate nitrogen metabolism for plants. Fungi also contribute a great deal to carbon conversion in the world.(5)

Their capacity for converting large amounts of substrate makes them an ideal means of conducting metabolic processes in an industrial context. They also have the advantage that they do not on the whole bring about complete lysis but perform only part stages. Another important advantage is that they finally yield the original substance again, either as a substrate or as a gas such as CO2. Bacterial metabolism on the other hand not only converts matter to heat energy, as mentioned above, but this energy is often converted to high energy matter and stored in the bacterium. Fungi thus are selfless in their metabolism, releasing the substance they have been processing. On the other hand they are also toxic, releasing their metabolic products unprotected into the environment.

Large scale industrial utilization of fungi started in the late 1920s. Citric acid is almost exclusively produced with the aid of fungi, annual production being more than 100,000 tons.(5) There is unlikely to be any field in the food and chemical industries where fungi do not play a major role. The numerous enzymatic processes used in the food industry also imitate fungal metabolism.

Rudolf Steiner characterized their growth, with degradation, decomposi- tion and excess of matter as dying life.(49) Compared to bacteria, fungi appear to take the degradation of matter only to a certain level. Thus fermentation, a self-limiting process with a relatively low energy yield, is one of their charac- teristics. They limit their activity in the conversion of matter, letting others take the process to completion. Constructive metabolism is taken care of by plants in the soil and by intestinal bacteria in the human intestine, in either case with the aid of light processes. It may be assumed that the attachment to dying processes seen in fungi means that humans suffering from mycosis are confronted with increased levels of toxic decomposition products.

This behavior towards matter, with retardation of a whole digestive pro- cess in favor of part processes, concerns an aspect of fungal pathology that has so far been given little attention. Fungi prevent the complete digestion necessary for the human organism. Humans need to convert all matter into a form that is their own. "Anything taken in from outside (into the human organism, author) must either merely be something that enables it to develop its own activity; or it has to act in such a way in the body that the foreign acti- vity does not differ from one of the body's own inner activities once it has en- tered into the body."(46) Fungi not only remain parasitic foreign bodies in man but also provide their host with a parasitic metabolism, at least in the intestine.

It has long been known that fungi grow more actively in sugar solutions. Vaginal mycosis thus develops quite often during pregnancy with its tendency towards pre-diabetes. This still calls for more large-scale studies. It seems that one-sided excess of matter with high-level sugar consumption favors fungal growth.

Ways of gaining insight into intestinal fungal growth in the light of the anthroposophical view of man

Behavior of I-organization and astral body

As one would expect, medical nomenclature tends to obscure the situation rather than clarify it. It is difficult to know if a fungus is "just there" (com- mensal), on the borderline to being pathogenic ("mutualist"), takes away important nutrients ("parasite") or is directly pathogenic by producing toxins or by means of invasive infection.

The basic process we find in humans with intestinal mycosis has to do with conditions Steiner described under the heading of neurasthenia. Patho- logical processes may develop if the upper and lower activities in the human organization are not sufficiently in accord with each other, with the upper not intervening adequately in the lower, and head processes staying among themselves.(48) The digestion is weak as a result, unable to assimilate foreign food matter adequately. The individual's attention is too much on the outside world, allowing foreign processes to enter to excess and meeting this with an excessive secondary reaction. These processes, which one also sees with allergies, were described by Rudolf Steiner.(47)

Weakness of definition may also be due to the opposite condition, which is the kind of hypersensitivity one sees with hysteria.⁴⁸ Metabolism makes itself independent, and wounds may be caused. An example of the overweening metabolic activity described by Steiner(48) would be candidal diaper rash of short duration when infants are teething. It generally ends when the teeth erupt.

Relationship to allergy

Allergies arise because foreign processes are not properly perceived. One often sees food allergies in conjunction with intestinal mycosis. The intoler- ance often only shows itself with a careful elimination and re-exposition diet. The human being is not able to register the foreign nature of the food nor the foreign fungal flora. In the author's experience people allergic to milk protein, hen's egg white, almond and soya tend to attract Candida rather than other yeasts. These are often people with an overweening metabolism who are more inclined towards hysterical disorders. People in whose stools Aspergillus has been detected will often show a neurasthenic component and have cereal grain allergies.

Fungal infection might be seen as a barometer indicating that the I- organization is not intervening adequately in the organism. Humans differ from animals in that foods must be thoroughly killed off and then built up again in a completely individual way.(50) With both allergy and intestinal my- cosis we may assume that the origin lies in a neurasthenic constitution. Meta- bolic predominance and hysterical wounding are then secondary phenom- ena. It seems likely that such foreign processes also appear temporarily in the course of acute diseases that weaken the constitution as a whole.

It is possible that fungi with their foreign substance are in themselves an allergen. It may also be possible that their presence "triggers" the actions of other allergens.¹⁶ Some patients with neurodermatitis do not improve with diet and constitutional treatment but only when their intestinal mycosis has been dealt with.

Fungal growth in the intestine has its own dynamics. The I or the I- organization cannot integrate them into its own growth principles. The result is that an area in the organism which is not under control is occupied by other life forms with foreign activity. In connection with the "bacillus theory", Steiner repeatedly said that it was the soil which mattered and not the bacillus. Fungi also work against the I-organization in another respect. They produce alcohols from higher fatty acids. These not only cause destruc- tion and toxic effects but also make people sleepy, weakening the human I- organization.

The activities of the I depend on warmth and light. Abnormal fat absorp- tion may cause too much or too little fat to enter the organism. In the first case one gets pathological heat foci, in the second, malnutrition.(46) Post's thermog- raphy shows intestinal areas subject to mycotic changes to be colder, possibly because the fungi act against the warmth organization. This would be another possible explanation of their negative effect on immune defenses.

Aspects relating to the treatment of intestinal mycosis

The main aim of treatment based on the anthroposophical view of the human being must be to give the I or I-organization and the astral body better access to the lower human being and intestine. Actual treatment of the mycosis is of secondary importance. The suggestions made below can, in the author's view, only be general. Treatment has to be individual to each patient. An attempt will also be made to consider the treatments suggested in the literature and find the rationale for their actions in the light of anthroposophical physiology.

Eurythmy therapy

The main aim of this is to support the I-organization in its actions in the body. This calls for general treatment to promote health in soul and spirit, to support the human being in his activity. Steiner had a great deal to say about the digestion, devoting the whole of the 4th lecture in the eurythmy therapy course to it.(45) Eurythmy therapy is therefore the method that does most to strengthen the I-organization, for it directly addresses the activity of the human individual.

Nutrition

Many authors refer to the importance of the diet. The negative effect of refined sugar is stressed by all. This is understandable, for the preparation of sugar is one of the central functions of the I-organization. Taking too much refined and processed sugar, one relieves the I-organization of its function and thus weakens it. (55)

A special diet always addresses a person's will. Steiner thus also spoke of the helpfulness of a diet chosen of one's own free will and of the way activity is reduced by a diet taken in a purely passive way.(48) Many of the diets sug- gested in the lay press unfortunately ask people to follow the advice of others blindly. One also suspects that some have no proper foundation. Thus it is difficult to see how a fungus can be "starved out". The opposite view, that a low-sugar diet to "starve it out" would give the fungus an extra appetite for the intestinal wall, is equally difficult to understand. Many of the measures recommended in the literature weaken patients rather than strengthening them. Special diets are always "asocial" and egotistical by nature, as Steiner made very clear.(48)
They should therefore only be of limited duration.

A sudden change to a wholegrain diet which is difficult to digest may also prove harmful. High proportions of roughage containing cellulose may induce fermentation with negative consequences.

The foods we eat relate to some degree to our organs. Foods that influence the liver, such as artichoke, are therefore recommended. A root diet with its mineral content strengthens the astral head powers in the upper human being, with the result that he no longer has to be active in metabolism. Lactic fermentation products such as sauerkraut or yogurt strengthen the astral body.

Strengthening the I-organization medically

Medicines based on quartz or silica serve this purpose. According to Steiner, "silica is the external correlate, outward directed activity for the I-organi- zation" (47) or "the physical basis for the I-organization."(46) Treatment with Cichorium also comes under this heading, for instance as Cichorium/ Pancreas comp. pilules (Wala).

Stibium supports delimiting processes in the intestine, also if the basic problem is an allergy, Antimonite 6x trit. (Weleda) being an example. Kalium aceticum compositum dil. (Weleda) or Plumbum Ix/Stannum 14x trit. (Weleda) facilitates I-organization intervention or its delimiting function. Finally all mercury preparations help the mercurial process in which the I- organization is active in the small intestine. Respiratory function in the lower human being can be encouraged with an iron silicate preparation, e.g. nontronite 12x trit. (Weleda). Treatment with roots containing pigments or extracts of these would also go in this direction - carrot juice, beetroot, aloes.

Phosphorus and sulfur based medicines to strengthen the lower abdomen

The relationship between phosphorous flowering processes and the lower abdominal organs was shown by Steiner. (48) All medicines based on flowering plants have this effect, wormwood for example, with the flowering green part of the plant used (Absinthium Ix dil., Weleda). Treatment with Aloe (Ix dil., Weleda), Resina Laricis Ix dil. (Weleda), propolis extract, evening prim- rose oil (Epogam(R), Gammocur or similar), borage oil, garlic (Allium sativum Ix dil., Weleda) or onion (Allium cepa Ix dil., Weleda) or Myrrhinil intest, a preparation based on chamomile flowers, birch charcoal and myrrh. Fern and bracken spores, e.g. in Digestodoron (Weleda) or Aquilinum comp. pilules (Wala), have the sulfurous character of the spores as their active prin- ciple. Steiner referred to their action as strengthening the catabolic principles in the digestive tract.(47)

The effect pigments have on the astral body is also an important aspect of diet - beetroot, carrots, roots, leaf vegetables. The common aspect to this treatment is that the powers of light are enhanced in the intestine.(49)

Suggested treatments for intestinal mycosis thus resemble those for warts or worms, where the weakness of the astral body towards external influences is increased. Thuja is also used for this.(48)

The phosphorus process exists also in the antimycotics used in conven- tional medicine. These contain either pigments such as gentian violet with its surface action, or they may be regarded as pigments, azoles, for instance (micononazole, ketokonazole, fluconazole), or may be chemically converted to pigments. Tonoftal is not a pigment but a high-energy substance. As their action is purely physical, the effect often lasts only for as long as they are given. Etheric activity has to take over. If this does not happen, or we do not aim to make it happen with treatment, the danger of resistance developing is great also with fungi,(9) though this was not considered possible in the past. Instead of giving chemical antimycotics one may also try relatively high vitamin C doses, 1/2 tsp t.i.d., starting low and gradually going up to this. Sandthom77 (sea buckthorn) original or "low sugar" elixir (Weleda) have a similar effect.

Insufflation of ozone into the intestine is another sulfurous type of treatment. About 200 ml are produced using a generator and insufflated into the rectum using a syringe and catheter. The ozone is bound to break down pretty quickly at body temperature, and its effect as a substance probably does not go beyond the sigmoid, yet convincing results have been seen in treating severe neurodermatitis with Candida confirmed in the stools.

Sugars, bitters, tannins

Roots with their sugars, bitter principles and tannins directly stimulate I, astral body and physical body activity (GA 319). This strengthens the totality of the upper human being's activity in the digestion. Instead of a pathological head-development in the lower human beings, as in the case of malnutrition, one has penetration of the digestive functions. Examples are Gentiana lutea (Gentiana lutea Rh 5% dil., Weleda, or Gentiana comp. pilules, Wala) or Geum urbanum Rh D3 dil. (Weleda).

In the author's experience there is a point to focusing on particular organs in treating different forms of intestinal mycosis. In his experience, treatment with the emphasis on the liver is effective with Candida mycosis, giving Hepatodoron, Chelidonium, Taraxacum or Cichorium, for example. Aspergillus mycosis appears to be more of a kidney problem, and Carbo Betulae or Equisetum may be considered, possibly in form of Equisetum cum sulfure tostum 6x trit. (Weleda).

Pancreatic extracts or bitters to encourage secretion are also helpful, Pancreas Ix trit. (Weleda), for instance. Cichorium/Pancreas comp. pilules (Wala) or Cichorium Rh 3x dil. (Weleda) may also be considered. Treatment with pancreatic enzymes may sometimes serve the purpose, possibly in combination with bile acids, or also gastric acid substitution.

Antagonism between bacteria and fungi

Another approach to treatment involves substitution and promotion of the physiologic intestinal flora. Steiner spoke of antagonism between bacteria and fungi in 1924.(49) A wide range of preparations is now available that con- tain Bifidum bacteria, lactobacilli, Bacteroides or Bacterium subtilis. Though widely used, data are not really adequate in this field. Many preparations contain lactose or milk protein, which has to be taken into account if there are allergies in this direction. Treatment has to be long-term, which means it is more costly. If the choice of substitution is right, the method does, however, frequently prove effective.

Guided symbiosis is said to influence immune functions. Again it has to be continued for some time. One often starts with a preliminary phase using metabolic products of E. coli (e.g. Pro Symbioflor, Colibiogen, Rephalysin or Hylak). The next phase is with lactobacilli or coccal preparations (Symbioflor 1, Acidophilus, Eugalan, Paidoflor) to stimulate the acid-producing flora.

Thirdly one would try substitution with Coli bacteria to restore the milieu, e.g. with Symbioflor 2 or Mutaflor. Others recommend Coli substitution only, to match the development of the first flora in the newbom. Some laboratories specialize in producing individual symbiont preparations based on an analysis of the intestinal flora. These methods, too, are often effective but costly.

A principle Steiner mentioned in the Agriculture course(49) probably has not yet been systematically applied to clinical treatment for humans. He suggested river or wetland meadows among the fields. "For if we manage to have not only woodlands (birds live above all in softwood trees, mammals in shrubs and bushes, author) but also river or wetland meadows suitably close to the farm, these meadows will prove particularly helpful to farming in that they provide a good soil for fungi. And one should see to it that the soil of those meadows contains fungi. You will then make the strange discovery that where you have wetland meadows, meadows rich in fungi... close to a farm, these fungi will because of their relationship to bacteria and other parasitic creatures keep such creatures away from others. ... The right balance and placing of woodland, orchards, shrubs and bushes and wetland meadows with a certain natural fungal culture is so much the essence of a good farming situation that one may even have to reduce the area utilizable for agricultural purposes to some extent...".

Displacement treatment using apathogenic yeasts

This has been used in a particular section of natural medicine in recent times. The yeast referred to as apathogenic which is generally used is Saccharo- myces boulardii.(6, 13)

Nosodes - out with the old

Finally nosodes or similar preparations are used to influence the retarded development aspect. As fungi are connected with the ancient Moon stage of earth evolution,.(41) man must let go of that aspect and take his evolution forward. This may be the rationale of Monilia albicans 30x pilules (Staufen) or Albicansan 5x dil./ Nigersan 5x dil. (Sanum Kehlbeck), for example.

Prospects

Candida infections are on the increase, above all in patients with immune deficits, in premature infants, and indeed with epiglottitis. Fungi are also getting resistant to antimycotics, probably by selection of resistant strains after antimycotic treatment. (9)

Unfortunately the issue of an abnormal intestinal flora, e.g. "dysbacteria" or "overgrowth syndrome,”(42) is mainly discussed by physicians working with natural medicine. This should not be a matter for division between conventional and natural medicine but for more intensive basic research. Koletzko and Baumler-Meri(22) are right in asking that the discussion should be more objective and not emotive. This would also mean that patients' feelings of being unwell must be taken seriously.

It may be justifiable to refer to psychopathologic phenomena in many instances.(11) But these only apply to a small proportion of patients. If both physician and patient are realistic in their expectations, the risk of aggravat- ing any hysterical and depressive desire to be sick, with "fungi in the intes- tines," is low. On the other hand there is no reason to put on airs and declare that this disorder does not rank as a disease at all.

Modem medicine clearly is still only beginning to get somewhere with fungus research. The literature relating to industrial uses is vast. But the last investigation of fungal infections in German swimming baths is more than 10 years old.(12) The simple treatment of oral candidiasis is also less effective than is often thought.(19) Nor are people in the habit of giving much thought to the matter of intestinal homeostasis, as may be seen from a paper by B. Koletzko, who denies the existence of problems due to the wrong bacterial flora. Patients experience a lack of understanding, with the result that attempts at lay treatment are common. The modern school of medicine must be challenged to pay attention to these syndromes and not deny their existence.

To date, then, Candida mycosis is not an accepted disease entity, and work has not gone beyond the description of individual cases. The uncer- tainties that exist in relation to diagnosis and treatment have to be accepted. They make it possible for practitioners to refuse to accept intestinal mycosis as a syndrome or to include it in their own critical review of potential treatments. Until firmer data are available, the positive results of a treatment must be accepted "ex iuvantibus". It would not be the first time that new perspectives have arisen in medicine by humbly taking note of existing uncertainties.

Karl-Reinhard Kummer, MD Posselstr. 7 D-76227 Karlsruhe Germany

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l am grateful to G. Soldner and H. Kienefor their suggestions.