Dr. Michael McNett is President and Medical Director of The Paragon Clinic, a Chicago multidisciplinary clinic specializing in treating fibromyalgia and muscular pain. McNett has seven years of experience in Family Practice and over nine years in Emergency Medicine, with additional training in addiction treatment, pharmaceutical research, and integrative medicine. Dr. McNett has some interesting thoughts to share about candida (yeast) overgrowth, and the connection to thyroid problems and fibromyalgia, as well his recommended treatments, based on success he's had with his patients.
Mary Shomon: In your practice, you see many patients with fibromyalgia and hypothyroidism. Have you found that there is a higher than usual incidence of candida in these patients?
Dr. Michael McNett: Very much so. We have known for many years that hypothyroidism causes fibromyalgia; all newly diagnosed fibromyalgia patients routinely get a thyroid profile to see if this is present in them.
In my experience, many patients with fibro who have normal lab tests still have symptoms of hypothyroidism. Most of these patients test positive for candida hypersensitivity syndrome.
Mary Shomon: Do you find that fibromyalgia or hypothyroidism symptoms also improve after a candida infection is treated? Why do you think this is the case?
Dr. Michael McNett: One thing that is very interesting is that treatment for candida hypersensitivity frequently causes all hypothyroid symptoms to disappear. Because of this, I feel that when the immune system attacks the candida cell, some chemical must be released that interferes with thyroid hormone's ability to cause its effect in the cell.
Thus, at least in these patients, the sequence goes like this:
Something causes their immune system to aggressively attack candida cells that most of us tolerate
Immune attack causes rupture of the cells and release of their contents
Our bodies absorb chemicals released by the yeast, which interfere with thyroid hormone's ability to cause its effect in the cell, and
the patient develops fibromyalgia symptoms.
Thus, the candida leads to the fibromyalgia and hypothyroid symptoms.
Mary Shomon: Why you you feel this doesn't this show up in thyroid blood tests?
Dr. Michael McNett: The receptor for thyroid hormone (that protein that sits on the DNA) has several types. The type that is present in the "thyroid thermostat" (the parts of the brain, pituitary gland, and thyroid gland that set thyroid hormone levels in the blood) is a different type than the one present in the rest of the brain, skin, muscles, bones, and connective tissue. I believe the chemical from candida affects only the latter type of the receptor, so the "thyroid thermostat" is uninhibited, causing the blood tests to be normal.
Mary Shomon: What are your thoughts about how blockage of thyroid hormone's effect can cause fibromyalgia?
Dr. Michael McNett: Thyroid hormone works by binding to large proteins covering genes on our DNA. If these proteins are strongly attached to the DNA, the genes are inhibited. If the proteins lift off and expose the DNA, the genes act as a "blueprint" for making enzymes to do various functions in the cell.
There appear to be two main DNA regions covered by proteins affected by thyroid hormone. The first one covers genes for a number of enzymes involved in energy production, and, when thyroid binds to it, it lifts up, causing more of these enzymes to be made. The other covers genes responsible for the production and detection of Substance P, which is responsible for pain sensation. When thyroid binds to this protein, it sticks tightly to the DNA, reducing production and detection of Substance P.
Thus, low thyroid effect causes decreased metabolism (fatigue, poor mental functioning, etc.) and increased pain sensation. These are exactly the problems experienced by patients with fibromyalgia.
Mary Shomon: What particular tests do you use to detect candida?
Dr. Michael McNett: There are a number of tests available. You can test for anti-candida antibodies in the blood, test how much candida is in the stool, and even do skin testing for allergy to candida. Frankly, none of these tests are perfect. I've found that a simple questionnaire is as accurate as these tests, and it's free. We can still use a test, though, if the questionnaire has a borderline result.
Mary Shomon: What is the most effective approach you've found for treating candida?
Dr. Michael McNett: There are three main aspects to care. First, a low-carbohydrate diet is critical, since it starves the yeast and prevents them from growing back. Second, nystatin (or another antifungal) is used to drive the yeast counts as low as possible. I prefer nystatin to the other alternatives because it passes through the digestive system without being absorbed into the bloodstream, so there are far fewer side effects. Third, acidophilus, which secretes lactic acid and inhibits the growth of yeast.
Mary Shomon: How long do you think candida treatment is needed for it to be effective in most patients?
Dr. Michael McNett: Generally, we find that if a patient does this for six months, their immune system will start to "cool off" and stop attacking the yeast so aggressively. This allows them to get off the nystatin and start to slowly liberalize their diet. For most people with this problem, however, they can never eat large amounts of sugar, refined flour, etc., without causing their symptoms to flare up again. In that sense, it's sort of like being told that you have diabetes.
Mary Shomon: How effective is candida treatment for fibromyalgia patients?
Dr. Michael McNett: It depends on the patient. Some fibro patients don't test positive for candida; for them, it's of no benefit. Some patients respond dramatically - I even have some people who have been on disability for years who are completely asymptomatic. (One was so grateful she even called Oprah trying to get me on there!) For most of those who test positive, treating the candida will cause a significant improvement in their symptoms; usually more than they've experienced from any other fibro treatment. Because of this, I routinely give the questionnaire to all my fibro patients, and, if they test positive, it's often the first treatment I use.
Mary Shomon: There are many people out there without fibromyalgia who have symptoms of hypothyroidism (obesity, low body temperature, inability to tolerate cold, dry skin, hair falling out, etc.) and who have normal thyroid profiles. Do you believe they have candida syndrome?
Dr. Michael McNett: It's very possible. Not all people with hypothyroidism get fibro. But many people with candida get hypothyroid symptoms, whether or not it develops into fibromyalgia. If a person feels like he or she is hypothyroid but tests are normal, it would be a good idea to be checked for candida.
Mary Shomon: Could that be a challenge for some patients? Will most doctors do that?
Dr. Michael McNett: Usually not. Dr. Crook, who developed the idea of candida hypersensitivity syndrome, didn't publish his findings in the medical literature - he wrote a book instead, The Yeast Connection. As a result, he blew his credibility with most of the medical profession, so most doctors don't believe this syndrome even exists. One of the reasons I created The Paragon Clinic was to do the research that proves that this problem is real and that treating it can dramatically benefit many fibro patients.