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Carbohydrate consumption and thrush

Hey Crohnies. I've done a bit of searching, so apologies if I'm making a new thread where one is not needed (my Google-fu is pretty good. My Crohnsforum-fu, not so much). I'm actually posting a few things today (like with email, I tend to save up all my forum-ing and do it at once), because I recently got diagnosed.

As in ten days ago. But as I've written in the Your Story forum, I've been chasing this diagnosis for 18 months, and I've been having various symptoms (mostly abdominal pain of different kinds and severities, as well as numerous - as in literally, I can't count them - peri-anal abscess) since I was 15. I'm 35 now. Yikes.

Anyway, one thing I've always struggled with as a lady-person is persistent thrush (I'd apologise for TMI, but this is a Crohn's forum, I reckon we're pretty good with the downstairs area). It's never made my life a living hell like it has for some people, but I've had a few persistent infections that took a while to clear up, and it happens a lot.

About a year before I started looking for a diagnosis (thanks to an intern who told me my abscesses did NOT look like hidradenitis and asked which hack had failed to do a colonoscopy), I went on a ketogenic diet. Like most Crohnies (I guess?), I'd struggled with discomfort in the belly region and tried cutting out or avoiding various things, including doing a FODMAP test (no fructose for me, damn it, and limited lactose only). I went low fructose and felt better (involves cutting out wheat, which is relevant to this story). Then I felt sick again, after eating. So I went low GI / low fructose. I tried to get the most slow release, non-wheat, non-fructose carbs I could find, avoided sugar like the plague, and tried to consume a bit more fat to slow down absorption.

This worked for a while, and then I started to feel sick again.

"Sod it," I thought to myself, "let's go all the way." I was so tired of feeling sick after eating. So I went keto. That's <50g carbs per day, and a high fat / moderate protein diet. I did all the maths. I tracked everything. I weighed everything.

And I swear to god, it worked. It worked better for the nausea and my cycling energy levels than anything else.

The abscess areas in my butt region stopped swelling up so much (I still got an abscess, but I got them with so much less frequency). I felt less sick. I slept better. And to my shock and surprise - although it took me a while to notice - I stopped getting thrush.

I've tested this a few times (not on purpose). It's hard to stay keto when you're travelling or on fieldwork (I'm a marine biologist, I need to hit the road - or the ocean - sometimes). So I break, and eat carbs.

And BAM. I feel sick. My belly hurts more. AND I GET freaking thrush.

Without fail. Every damn time.

I know that candida overgrowth is often related to immune system suppression, and I have actually seen a lot of threads on here about how it correlates with various steroids and biologics and immunosuppressants, but at the start of all this I had never been on any of those medications (I'm now knocking back 9mg Budesonide EC, and GI wants to put me on Imuran - appointment on Friday).

But here's my question - has anyone else had a link between carb consumption and thrush with Crohn's? Is this yet more evidence that I have a carbohydrate malabsorption issue?

Other evidence that way is that, when I eat carbs, I am CONSTANTLY hungry. It's ridiculous. I can put away a ludicrous amount of food. And I do gain weight - but running the numbers, I don't gain NEARLY as much as I should, even given that I'm very active. I'm so hungry I'm nauseated.

My running theory - and I could be just pulling this out of my scarred backside, true - is that (1) I do absorb some carbohydrate as the damage is mild, but not efficiently and (2) this means that I have undigested sugars hanging about in my gut from this secondary malabsorption. My gut flora goes insane and happily chows down on this free sugar (om nom nom) and this leads to candida overgrowth, because of all this fuel.

One of the reasons I'm asking is because, with Imuran in my future, I'm a bit concerned this problem will get worse.

I'm also struggling to understand how different parts of the gut are affected and how that affects nutrient absorption. i.e., apparently the middle and distal parts of my ileum are covered in patchy inflammation, my colon is clear, my stomach and proximal end of the small bowel is clear; my B12 is VERY high (actually outside testing parameters), my liver stats are fine, my iron is low, it's all very confusing and inconsistent.

Anyway, I'm a very verbose person, so thanks for reading all this through, and I hope it makes some sort of sense. Cheers m'dears.
You mentioned gut flora. Have you tried probiotics. They balance the good bacteria with the bad. This might help with the concerns about imuran. You also mentioned that you keep getting abscesses. I wonder if you have one that never healed. Ask your doctor.
Hi Ronroush, thanks for the quick reply! Yes, I'm on probiotics - particularly the "urogenital shield" kind, as they seem to be the most effective for protecting against thrush and bacterial vaginosis, the things that happen in that area when the flora is out of whack. It seems to help keep everything humming along when I'm on keto (as in, I do get occasional issues when low carbing, but way less than I used to, and taking the probiotics seems to have knocked that out), but isn't enough to protect me when I drop the ball and start inhaling carbohydrate. I'll ask my GI if I should be taking something else - I honestly just picked this up off the pharmacy shelf and decided to give it a go.

Re: the abscesses: I suspect there was at least one fistula that was making life unusually difficult. It's now been dealt with surgically (it was TINY. Apparently one of the tiniest fistulae he'd ever seen, and still enough to cause so much trouble!). I do still get some accumulation happening in multiple areas - I can feel the pressure under the skin, if that makes sense. But I've had an MRI to look for other fistulae, and even though they thought there was a "maybe?", the surgeon couldn't find it for love nor money.

I think what's happening with the abscesses is that it's more to do with the inflammation directly - so when my gut is inflamed and painful past a certain point, I get accumulation happening, which again, is worse when I'm eating a lot of carbohydrate. This would make much more sense if there *were* an active fistula, I think, since there would be a direct line from "overgrowth of gut flora" to "here is a bag of pus inside you!" But nothing has been picked up so far.

Food for thought though, and something I'll raise with my GI (I'm making a long list of questions for the man).


You are correct. Candidiasis is now thought to be a major cause of flare ups. We apparently have a predisposition for candidiasis. I found nystatin to work the best. It is prescription. Something that works equally well on me is Candidas , sold online on Walmart.com. It is non-prescription. Also I only avoid soft drinks. I eat what I want with no ill effects.
So I struggled with thrush terribly for quite awhile. I recently had my tonsils out and started drinking kombucha everyday. It actually helps fight yeast infections, which is what thrush is. I've been feeling really good since starting that. I even started brewing my own kombucha at home. It's a fermented tea. Has a lot of probiotics, a lot of vitamins. it's maybe worth a try? I know I had reduced my carbs and sugar intake when I had dealt with the thrush and it did help but never really went away. Good luck!
I am thinking along the same lines as your running theory. From what I understand fructose and lactose are digested in the same area. If the finger like villa is damaged the enzymes found within are not able to breakdown the sugar molecules to glucose. Leads to malabsorption. I have also dealt with yeast, which if I probably corresponded with larger than normal sugar consumption. Also suffer headaches caused by too much sugar in the system. I I truly thought I was eating healthy. Lot of healthy food is high in fructose. Ie watermelon, honey, wheat. I've been taken off dairy, wheat and sugar, which has helped. Still learning what and how much I can tolerate.