The "candida overgrowth syndrome" (COS), touted in the popular press as the cause of a long list of nonspecific and apparently unrelated symptoms, is something in which most physicians don't believe. Why should we in fact believe in COS if there is nothing objective to verify its existence? 

On the other hand, if there is objective data suggestive of COS, what intellectual basis do we have for rejecting it? Take for instance the thin 40-year-old woman who saw me recently with a seven-year history of diarrhea associated with a 15-pound weight loss. Since one week after the birth of her son she has had up to 10 loose bowel movements daily. An EGD and colonoscopy revealed ulcerations from her esophagus to her colon but all other stool and blood tests were negative. No definitive diagnosis was made, but she was treated with prednisone on the clinical suspicion of autoimmune disease. When I saw her for the first time in September of 1998 we drew a blood test for candida-specific antibodies (IgG, IgA & IgM). The IgG antibodies were elevated at 215, the IgM antibodies were normal and the IgA antibodies were astronomically elevated at > 400 (normal for all of these is < 25). She has been treated with Diflucan for one month and has had only two loose bowel movements since then.

Obviously, I have picked a dramatic case to illustrate a point. There are many patients who are convinced they have COS whose suspicion is not confirmed by blood antibody tests. However, there also appear to be legitimate cases of COS which can be documented by objective data. If we categorically discard COS as a pseudodiagnosis and neglect to even conduct appropriate testing, we may miss out on a very treatable condition. I would consider testing for candida-specific antibodies in the following situations: chronic illness associated with steroid use, elevated sugars, recurrent antibiotic use or recurrent yeast infections.

Does a tree falling in the forest make a sound if there is nobody there to hear it? Does COS exist if a physician fails to order the tests to prove it?