Candida is often the first thing that patients think has gone wrong in their gut. Frequently it is more complicated and often involves bacterial overgrowths, enzyme dysfunction leading to food intolerances as well as potential fungal overgrowths. That said, the more functional testing I do the more I realise that fungal and mould overgrowths and infections can be the major root cause for ongoing digestive symptoms. Today we are exploring three different testing options for candida overgrowths.
Candida infections 101
For a quick primer on Candida overgrowth symptoms and how it can damage your digestion check out a previous article – Candida infections – when harmless becomes harmful.
I have also put together a decent intro to Candida infections below
As a quick summary. Candida can be a healthy resident of a balanced microbiome. When given the right environment candida can overgrow and cause a whole range of digestive issues including
Testing options for Candida Overgrowth
In my practice I have used 3 different testing options to screen for candida infections growing in the gut.
Before we dive into each one and end with my current preferred method to test, let me just say no test is perfect. I have seen good tests miss Candida more than once. For this reason I prefer the organic acids test.
More on that later.
Stool Test for Candida
Let’s start with the most popular approach to testing for candida in natural health clinics.
Stool testing has come quite far from the culture and microscopy days. Now we have advanced DNA based tests like the Complete Microbiome Mapping stool test and Microba that can screen for candida in the large bowel.
When I see a result of a candida overgrowth like the one above I make sure to explore the relevant symptoms with the patient carefully. Is candida a major player in their symptoms?
For the most part I think that stool tests under report on the fungal infection front. I’m still not 100% sure why that is but the case study I share at the end of this article helped me to understand this stool test limitation.
Summary – Stool testing for candida is a common practice but is less reliable in my clinical experience.
Blood test for candida
Another option that is used to screen a patient for candida is antibody testing. I find that some patients’ doctors have recommended this testing option.
The main issue here is that the person’s immune system has to have recognised candida as an invader and mounted an attack on it. This is a prerequisite to a positive test.
Below we see a blood test right on the line for candida overgrowth and we are left with the question – is candida an issue for this person?
Summary – In my experience antibody blood testing for candida is more commonly practiced by doctors. I find it quite unreliable.
Organic acids testing for candida
Finally we come to my favourite way for testing for fungal overgrowths.
The OAT test (organic acids test) is my new preferred test for most of my patients. I have seen such significant results from this test that help to steer the treatment that I am considering making it a prerequisite test for all of the people I work with.
This test screens for bacterial and fungal overgrowths, metabolic and mitochondrial function, the state of your neurotransmitters, your ability to detox and even nutrient status.
Back to candida overgrowths. Below we can see an elevation in arabinose, a marker of a fungal overgrowth. This is the marker I frequently see elevated. While it doesn’t specify candida it does indicate probable fungal overgrowths. From there we can work backwards to symptoms and history to really reinforce the possibility.
When I see an elevation in arabinose and carboxycitric acid like the image below it reinforces the fungal overgrowth theory.
I am sure you have picked up on the vagueness in my descriptions.
With OAT testing I find myself using words like possibility and fungal overgrowth rather than the specific species. This is because the OAT test won’t tell you exactly what microbe you are dealing with.
At first I considered this a major issue and disregarded OAT testing as an option. Now I have come to see it as one of the most insightful tests on the market.
Here is why.
Organic acids testing results will give us an insight into how the body is compensating due to a fungal overgrowth. These include oxalate load, mitochondrial function, neurotransmitter imbalances, detox pathways and even certain nutrient deficiencies.
Excessive oxalate production is often a consequence of a fungal infection or overgrowth as seen in the test result below.
Candida has the ability to drive excessive oxalate production via the isocitrate lyase enzyme which hijacks isocitrate in the human krebs cycle, converting it to glyoxylate and then on to (extra!) oxalates.
Here is why we see joint pain and muscle soreness as a consequence of a candida overgrowth. The oxalate load, causing these symptoms, is merely a consequence of the fungal overgrowth!
So with the example above we know there is a fungal overgrowth and that the oxalate load is extreme. Treatments for this patient included lowering her oxalate intake from her diet, citrate based minerals to bind and detox oxalates and finally, antifungal herbs.
Summary – While OAT testing won’t identify the exact species overgrown, it will reliably tell you if there is a fungal overgrowth and how the body is compensating to deal with it.
A case study comparing testing options for candida
To really illustrate the value of the OAT test I want to share a case study from a patient of mine using the three testing options listed above.
She came to me with stool test results from the Complete Microbiome Mapping test from Nutripath. These results showed zero candida. Not her issue right?
From her symptoms and her intuition that there was a fungal issue going on the serum candida antibody test was ordered. Here we see a mild elevation in IgG but nothing to be concerned about.
As her treatment unfolded and our suspicion of some fungal overgrowth persisted, I recommended the Great Plains Organic Acid test currently my top choice for OAT testing. Here we see clear markers for aspergillus and candida.
After two false negative tests it turns out this patient was mould/fungi affected after all!
Test don’t guess
I have bounced between the testing and not testing approach for some time now. I think it was because no test is perfect and I frequently found that the test results didn’t change my approach.
All of that is in the past now that I have dug down and really worked out how to interpret the OAT test. It is a never ending journey. I joke to my patients that you need three different degrees to really understand what this test reveals, then I remind them that addressing the root cause, often gut imbalances, can help to resolve chronic illness.
Since I have started using the OAT test on a weekly basis I have found a number of candida overgrowths that I would have missed using stool testing and symptom presentation alone.