My esteemed colleague Dr Marshall Dahl has concluded that the “almost complete disappearance of formerly serious and prevalent problems such as chronic hypoglycaemia, chronic candidiasis, chronic Epstein-Barr infection, sero-negative Lyme disease, and toxicity related to dental amalgam” must have been due to “the efforts of the naturopaths and other alternative practitioners” (“Let’s support naturopathy,” BCMJ 2009;51[4]:150 [10]).

I am sorry to have to disabuse him of that notion—they have all moved to Victoria! Since arriving here in “God’s waiting room” they have increased their demands by asking to be tested for, among other things, Wilson’s low temperature syndrome and adrenal exhaustion, and asking to be treated with ThyroSense, Adrena­Sense, and bioidentical hormone replacement in addition to the black cohosh, ginseng, and dong quai they are already taking.

Vancouver’s loss is our gain!

—Gerald Tevaarwerk, MD
Victoria

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I would like to thank Dr Dahl for pointing out a number of formerly serious and prevalent problems that have almost completely disappeared from his practice (“Let’s support naturopathy,” BCMJ 2009;51[4]:150) [10].

In this discussion I elect to comment on one entity, chronic candidiasis, candida hypersensitivity syndrome, also known as Candida albicans overgrowth syndrome. It is not to be confused with chronic mucocutaneous candidiasis.

The existence of this presumed disorder is based on clinical pictures and dubious diagnostic questionnaires. There is no specific diagnostic laboratory test. In addition, “no clear definition of the disease has ever been advanced.”[1]

The proponents postulated that the “sensitivity” to candida present in the gastrointestinal tract was responsible for various systemic symptoms. They managed this presumed disorder by dietary manipulation and use of antifungal medications. It received much attention in the media and health magazines in the past. A position paper of the American Academy of Allergy Asthma and Im­munology in 1986 stated that the concept was “speculative and unproven.”[2]

There is no scientifically valid evidence that cell-mediated sensitivity to candida antigens, present in about 50% to 70% of normal adults, is responsible for this condition.

A randomized, double-blind, placebo-controlled study in 42 premenopausal women with the presumed diagnosis of chronic candidiasis was reported.[3] It compared oral and vaginal nystatin with placebo. It was found that nystatin did not “reduce systemic or psychological symptoms more than placebo did.”

In 1990 the New Jersey attorney general secured consent agreements barring two physicians from diagnosing and treating Candida albicans overgrowth syndrome. Both were assessed $3000 for investigative costs and had their medical licence on probation for 1 year.[4]

It is not surprising that this presumed disorder and others are pre­sently with “reduced incidence and prevalence.” It is interesting that the naturopaths and other alternative practitioners had been spending so much energy diagnosing and treating this presumed entity and others in the past, which are currently being barred in some jurisdictions.

I am not aware of any report ofevidence-based studies published in peer-reviewed, reputable journals supporting the validity of the various diagnostic techniques mentioned. I have come across some patients spending hundreds of dollars for blood tests ordered by and sent away to US laboratories by some of these practitioners. Many reports show numerous positive results not validated by patients or physicians.

With regard to colonic irrigation, there is an interesting article on colon therapy and related quackery on www.quackwatch.com [11].

We should always have an open mind to any complementary and alternative medicine. However, we should never lose sight of evidence-based approaches in the diagnosis and management of our patients.

—H.C. George Wong, MD
Vancouver

References

1. Bennett JE. Searching for the yeast connection. N Engl J Med. 1990;323:1766-1767. PubMed Abstract [12]
2. Candidiasis hypersensitivity syndrome. Executive Committee of the American Academy of Allergy and Immunology. J Allergy Clin Immunol. 1986;78:271-273.
3. Dismukes WE, Wade JS, Lee JY, et al. A randomized, double-blind trial of nystatin therapy for the candidiasis hypersensitivity syndrome. N Engl Med. 1990;323:1717-1725. PubMed Abstract [13]
4. Quackwatch. Dubious “yeast allergies.” www.quackwatch.org/01QuackeryRelatedTopics/candida.html [14] (accessed 21 May 2009).