Antifungals and Crohn's

[Pangolin]

Does anyone have any experience with antifungals on Crohn's? It seems like a somewhat promising area of research, but I don't think I've seen anything from any patients. I guess very few people have tried this out.

There's some evidence that Malassezia fungus may be involved in Crohn's. See this website: https://www.malassezia.org/i-love-details

There was a paper back in 2010 about some patients treated for histoplasmosis with itraconazole who apparently had some good results: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2036.2010.04444.x

And there are at least a couple of trials going on now testing out antifungals for Crohn's patients (specifically, oral posaconazole, itraconazole, and terbinafine in these trials)
https://clinicaltrials.gov/ct2/show/NCT04966585https://clinicaltrials.gov/ct2/show/NCT05049525

 

[asadmom]

@Ignotius, do you have any insight on this?

 

[Ignotius]

my feelings are along the general assumptions we may have.....like....balance of biome and such, reaching to the opposite direction of leaky gut anythings etc...

but then we arrive to.......what causes the dysbiosis to begin with? type questions....

which still to me.....points to what we put in our mouths before other things....however, once chrons has developed it brings a life of its own to the party i dont think we can deny....we agree this is caused by different reasons and in particular what we are seeing with children these days alone proves that....

but then.....that takes me to how i came at rebuilding my biome after surgery....and imagining things like this, as a part of a something like that....but really i have no idea of course.....so, for me, what i did was sort of bomb certain cultures in periodically....rather than taking all of them constantly......by now i am sort of reduced to simpler type things, but i still feel i could/should be doing more....

i take a few supplements aimed at biome balance or killing baddies more specifically....aged garlic, quercetin, monolaurin.....pre/post-biotics over pro tho......i could imagine doing something like this just in terms of maintaining harmony if a fungal imbalance was detected, but i wonder also about side effects etc, if, it could be possible to achieve the same result with less risk...

we can actually consider this in terms of horticulture for a comparison.......if you over-innoculate a plant those "good" microbes will eat too much oxygen, which means the population booms, then starves as the bulk of it dies....which invites a boom of pathogenic strains which can COMPLETLY shift the balance to a point of death.....but we dont exactly want to attempt sterility in the interest of "optimum"....more likely balance.

depending where people are starting from, i could see some things like this as powerful tools....even as an initial "flush" type idea.....to get the baddies out to people new to all this and trying to deal with problems inside later than they wished, or ppl noticing odd reports in screenings etc...

then again, it could always be some mystery correlation that works in an indirect way right...

keeping researching,
regards

 

[asadmom]

https://www.malasseziafoundation.org/crohn-s

 

[Crohn2357]

About a decade ago I used a powerful systemic antifungal drug to treat steroid-induced oral candida infection. The drug helped my Crohn’s (intestines) as well. The positive effect was noticeable, and I have always found that interesting.

 

[James02]

My doctor says I "likely have mild Crohn's, but can not prove it". But, I've taken Diflucan (antifungal) and I have also done a natural antifungals and have felt better after. Although, this has not been 100% of the time. Just my $0.02.

 

[kiny]

Fungi found in stool or biopsies don't necessarily indicate they have a permanent presence in the gut.

When doctors or researchers find fungi in biopies or stool samples, they tend to overhastily conclude that they have colonized the gut just like bacteria. But there's no good evidence fungi are capable of doing this, the anaerobic intestinal environment is no conducive to fungi. Unlike most gut bacteria, that require an anaerobic environment or are facultative anaerobic.

When people change their diet or increase oral hygiene, these fungi populations simply disappear from stool samples. One study showed that S cerevisiae disappeared after avoiding bread, but reappeared on a stool sample again simply after consuming one bite of bread. The same was true for increased oral hygiene and candida species.




Fungi are likely transient in the gut and they likely come from
-oral cavity
-food sources

And they likely do cause an immune response in crohn's disease, similar to how people with celiac disease are impacted by what they eat. This might explain the benefits of EN. The most straightforward explanation is usually the correct one when it comes to intestinal disease. Even though the intestine is highly complex, the explanations for foodborne infection, intestinal TB, celiac, etc....have all been incredibly straightforward.

 

[kiny]

The reason why several studies on fungal populations found in crohn's disease are seemingly in constant disagreement with each other, and end up having to contradict their own studies they did not long ago, likely reflect differences in dietary patterns in patients, and the transient nature of fungi.

Instead of taking stool samples of crohn's disease patients to come to a non-conclusion, the more interesting studies are those that can show an immune response to those, likely transient, fungi. The antibody response seen in ASCA testing and the CD4+ response telling us there is an immune response to these fungi in CD patients.

While I would be very happy to see those anti-fungal studies succeed, it would require fungi to be capable of colonizing the gut for them to have any effect. While there is a remote possibility that some fungi might be capable of this under very specific conditions, it is a lot more likely that the fungi measured in stool samples, are the from oral cavity or the diet, in which case anti-fungals meant to treat acute fungal infections, will have no effect in crohn's disease.

 

[James02]

When people change their diet or increase oral hygiene, these fungi populations simply disappear from stool samples. One study showed that S cerevisiae disappeared after avoiding bread, but reappeared on a stool sample again simply after consuming one bite of bread. The same was true for increased oral hygiene and candida species.

Hi @kiny;

I've noticed I've experienced sudden improvements in my Crohn's during times I took a parasite cleanse and/or taken antifungal. Do you think it's food related causing this fungal response?

I don't know much about Crohn's. I just know what tends to make me feel better and doesn't.

 

[kiny]

Fungi are abundant on skin, in the oral cavity and in food (bread, cheese, sausages, etc). Compared to bacteria, they are rare in the intestine due to the harsh anaerobic conditions. Less than 1% of the intestinal biome would be fungi (if they are transient or not is actively being debated).

The conditions for them to colonize the gut are not great.

Then there is the fact people with crohn's disease often have aphthous ulcers in their mouths. The fact there is some kind of environmental factor at play (clustering, people are more likely to develop crohn post-migration, etc). And lastly the fact EN taken orally seems to drastically reduce inflammation.

That doesn't mean anti-fungals would have no effect, but if the fungal suspects in crohn's disease are chronically being ingested, anti-fungals would unlikely be able to keep people in remission.