Candida overgrowth is a very common problem, leading to symptoms such as gas, bloating, irritable bowel, constipation and/ or diarrhea, lethargy and fatigue, brain fog, neurological issues and many more. Candida is a yeast that occurs in our large intestine – it is supposed to be there, and serves a good function as part of our natural microbiome. However, if Candida becomes overgrown, which can happen secondary to antibiotic use, a high-sugar diet, or other irritants in the gut such as food allergens or intestinal parasites, problems can arise. So how do we know if Candida levels are too high? There are three ways to test for Candida that can help us to see whether it is an issue.
Some people know when Candida is flaring up for them by their digestive symptoms, or by seeing a thick white coating on their tongue. I have known parents of kids on the autistic spectrum who know when their child’s yeast issues are flaring up because of the dramatic changes in their behavior. Most of the time, though, we do want to run some laboratory tests to see what is going on. Here are the three tests that I will look to – I have my favorite one (which I’ll talk about first), but in a perfect world we’d do at least two of the three:-
- Microbial organic acid test – this is a urine test that I run through The Great Plains Laboratory. It measures a number of markers associated with yeast, but to me the most useful one is called arabinose – this is a metabolite of Candida that shows up in the urine. I like this test because it is easy for parents to collect the sample at home – just a single morning urine. There are pediatric collection bags available for kids who are not potty trained, that go inside their diaper. I also like it because it really quantifies the problem. If the level is supposed to be less than 29, and it comes back at 35, then we know we have a slight problem, but not a massive problem. If the level comes back at 140, we know we have our work cut out for us! It’s also a great marker to check throughout treatment to make sure it’s going down in response to anti-fungal therapy.
- Comprehensive stool analysis – the comprehensive stool analysis checks for many things, not just Candida. It is not my favorite for Candida itself, the microbial organic acid test is; but what is nice about the comprehensive stool analysis is that it can give us some clues as to what else is going on: Are there parasites in the gut? Is the bacterial overgrowth? Are there any pathogenic bacteria showing up at high levels? How are secretory IgA levels? That gives a window into the immune health of the gut itself. Are there elevated levels of inflammatory markers? The comprehensive stool test can show if there are moderate or abundant levels of yeast in the stool; but I haven’t found it to be as reliable over time as the urine test for that specific thing. In a perfect world, we would have both of those tests run (Great Plains also offers the comprehensive stool analysis).
- Blood antibody markers for Candida – IgG, IgA, IgM. Immunoglobulins are immune cells that will show elevated on a lab test in the presence of a certain pathogen. This is often how infectious diseases are diagnosed, through immunoglobulin levels. For instance, if you have acute mono, you will likely show IgM antibodies for the Epstein-Barr virus, indicating active infection. If you had mono five years ago, you are still likely to show IgG antibodies, as protective/ memory cells to the infection. I have found Candida antibodies to be less sensitive than the other tests in trying to establish whether there are yeast issues in the gut. I have seen cases with high arabinose and other yeast-sensitive markers on the urine test, but no elevations in the blood immunoglobulins. The Candida problem needs to be quite systemic before blood immunoglobulins are going to rise, where I think the urine and stool tests are more sensitive to intestinal overgrowth itself. Also, this test requires a blood draw which may not be a favorite thing for our kiddos. The pluses are that any lab can run these tests, and insurance is more likely to pay for them.
These are the three tests that I run for assessing Candida overgrowth, listed in order of my most favorite to my least favorite. I have done tons of the microbial organic acid tests and continue to find that one the most helpful, cost effective and easy to implement. If there are major gastrointestinal issues I’ll also want to see a comprehensive stool analysis and an IgG food sensitivity test to try to get a complete picture of what is going on.