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NYSTATIN RESISTANCE? - Once

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NYSTATIN RESISTANCE? - Once & for all, time for the truth!!!

Posted by Tim on March 20, 2000 at 13:39:58:

Dr. Stoll,

I came across your wonderful site & am trying to sort through various bits of information I have come across regarding long-term Nystatin usage. Since you seem to be quite knowledgeable in the area of intestinal candidiasis & dysbiosis, I thought you would be able to sort through this area of confusion and frustration. It seems there is still much confusion as to whether Nystatin has ever produced resistant organisms IN VIVO. There isn't a week that goes by that I don't hear it from other practitioners (mostly DCs & other non-MDs) & clients as well. I have spoken to Dr. Truss who still says NO WAY & says that only Amphotericin-B & Diflucan have produced resistant strains (in vivo?). There has been much banter about long-term Nystatin usage causing "cell-wall deficient organisms", "resistant strains", & that C. Tropicalis is resistant to the drug, etc. To my knowledge, in order for a fungus to become resistant to nystatin (or any of the currently available antifungal drugs) the organism would have to mutate to a form that uses a different lipid than ergosterol in its membranes. I am only aware of two reports in the literature of resistance, and when the organism in question (Histoplasma capsulatum, in one instance, and Coccidioides immitis, in the other instance) was submitted to researchers, they could not confirm the resistance. Truss also says resistance has NEVER been proven in vivo. Further, when reading a description of Nystatin, it says it is both fungistatic and fungicidal against ALL species of Candida. Truss therefore vehemently defends Nystatin, as he has for several years, and says he has had patients on it for years, if necessary, even decades, without any problems. Some patients can stop it & remain in remission, while others may relapse, especially if they lapse on their diet. Further, Truss recommends that if a strain of Candida is particularly virulent, or even “resistant”, increasing the dosage to as much as 2 teaspoons 4 times/day would kill it. Nonetheless, I always like to keep an open mind, as it would seem logical that resistance could be the case. Here are the specific "theories" being thrown around:
1) "Prolonged administration of Nystatin causes Candida to mutate to more difficult to treat strains such as C. tropicalis and others."
2) "In cases of combined infection of various yeasts and bacteria, relapses often occur because Nystatin may be effective against C. albicans, while barely inhibiting some of the more virulent non-albicans strains. The result then, is a superinfection in which Nystatin actually causes a less aggressive yeast to be replaced by a more pathogenic one, and a worsening of the patients symptoms (and infection) despite the use of Nystatin." (So - if a patient did test + for a different strain of candida, wouldn't the symptoms be clearly and definably different and that would be a telltale sign of resistance)?
3) “Allergy (chemical hypersensitivity) is common after prolonged administration.” In terms of the allergic potential of the drug, what has been your clinical and/or anecdotal experience?

With all theories & facts aside, I believe the biggest as yet unsolved mystery of mysteries would be discerning between:
a) Symptoms of hypersensitivity to the drug itself.
b) Symptoms from die-off or detox from the toxins released from killing the yeast.
c) Symptoms worsening from growth of a resistant strain from using the drug for a prolonged time.

The ability to answer this question would save much needless suffering to say the least!

I wouldn't be consulting your advice if I was so confident like Truss, but with everything you hear in the course of practice, I like to always keep an open mind for the contradictions - as long as there is some truth to those contradictions. I appreciate helping me cut through this confusion once & for all.

Regards,

Tim Silvestri, Ph.D.





Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida.

Posted by Walt Stoll on March 21, 2000 at 09:49:35:

In Reply to: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! posted by Tim on March 20, 2000 at 13:39:58:

Hi, Tim.

First, I believe you need to take into account the biases and financial reasons for some of these positions. Although Nystatin is SO safe that it should not BE "by prescription only". The AMA has been able to keep it so just to maintain one more thing that non-MDs cannot use.

SO, non-MDs tend to bad-mouth it and MDs tend to "good-mouth" it.

I agree with Orion Truss (By any measure, he has to be one of the world's experts in Nystatin.) in that at least the hypersensitivity to it and the "resistance" factors are SO uncommon as to be vanishingly rare and must be dismissed as any reasonable consideration. I do not say that they are impossible since humans are infinitely complex and anything is POSSIBLE.

HOWEVER, in MY experience, the way to eliminate candida is to get rid of the susceptibility factors FIRST and then, if needed, proceed to eliminating the organism itself. The candida is all around all of us all the time. Those of us with a normal colonic bacterial ecology do not get it and those of us with dysbiosis (always due to LGS) frequently DO. By focussing on the candida, what is to keep the person from getting it back from the sea of candida yeasts in the environment even after it has been totally eliminated??

By going at it that way, no one needs to take Nystatin more than 6 months (most only 3).

I appreciate the effort you have put into this question. However, I DO think that your efforts are misplaced. If you put 1/10th the amount of effort into understanding the larger picture, you would resolve more cases in less time.

Hope this helps. This entire subject has been discussed for years on this BB and is available to anyone using the search engine.

Walt



Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida.

Posted by Tim on March 21, 2000 at 23:25:24:

In Reply to: Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida. posted by Walt Stoll on March 21, 2000 at 09:49:35:

Dr. Stoll:

The single basic intent of my original message was to eliminate the confusion surrounding Nystatin, but since you expanded the topic to a more global view of treatment, which any practitioner worth his or her salt should do, I just would like to clarify some things from your response:

When you mention, "the way to eliminate candida is to get rid of the susceptibility factors FIRST and then, if needed, proceed to eliminating the organism itself", I'm assuming by "susceptibility factors" you mean ruling out underlying possibilities such as mercury, parasites, bacterial dysbiosis, hypothyroidism, chronic stress, EBV, etc. FIRST, then using antifungal therapy, i.e. Nystatin, only if indicated, correct? If I've interpreted your response correctly, then what you're saying is that unless you fully explore and rule out (via testing and clinical observance)these other detriments, soley treating the candida using antifungals will only be a TEMPORARY "bandaid" in most difficult cases, right? In other words, rarely will any amount of Nystatin or any antifungal indefinitely "cure" a patient if there's an underlying chronic problem with these endogenous or exogenous factors.

IMHO, attaining a normal or healthy balance of gut flora is such a cornerstone of maintaining health, if not THE single most important aspect of clearing the body of pathogens, i.e. candida (Truss said that prior to the use of Nystatin, Acidohilus was the "drug" of choice used to treat yeast infections), but I have found FEW, if any, current over-the-counter probiotics on the market that have been potent enough to survive the stomach acidity & implant where they're supposed to in order to achieve true colonic harmony. If you know of any, please advise.

p.s. I still would like your opinion on how one would discern between:
a) Symptoms of hypersensitivity to the drug itself.
b) Symptoms from die-off or detox from the toxins released from killing the yeast.
c) Symptoms worsening from growth of a resistant strain from using the drug for a prolonged time.

Once again, thank you for your help!

Regards,

Tim




Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida.

Posted by Walt Stoll on March 22, 2000 at 12:51:53:

In Reply to: Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida. posted by Tim on March 21, 2000 at 23:25:24:

Hi, Tim.

I hope you did not take anything I said personally.

First, the understanding of C-RS has gone far beyond what Orian Truss knew. That is the way of great discoveries (like Truss's). They are expanded by others who owe their initial understanding to Truss but are not limited by what he discovered.

The LGS, that made the person susceptible to the C-RS is what has to be dealt with. Rare, indeed, will be the person who cannot be shown to have LGS if they are proven to have C-RS.

All of the things you listed as causes are instead effects of the same things that cause LGS.

Next, Metagenics and Klair Labs both make stabilized acidophilus of certified at least 6 billion live organisms per dose.

There will be an occasional patient who does not have to get rid of their LGS to finally keep candida gone. However, even they will have to be treated for at least a year to resolve the candida. That is a waste, in MY opinion, when we now know how to eliminate both problems in 3-6 months IF the person will apply themselves to what we know to do. They at least deserve the choice.

I have no experience with #1 & #3 of your questions. I have only treated about 1000 cases snd all the symptoms ascribed to these causes were found to be due to withdrawal in an imperfectly done diet. As soon as the refined carbohydrates were compulsively eliminated, the symptoms ceased within 3 1/2 days.

IF the LGS is dealt with first, the incidence of #2 is only about 1/500 cases and that can be dealt with just by having the person understand that the die-off symptome are a good sign that we are on the right track and that they will only last less than one week ( which is how long they do when the diet is not causing withdrawal).

Hope this helps.

Walt



Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida.

Posted by Tim on March 22, 2000 at 16:29:34:

In Reply to: Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida. posted by Walt Stoll on March 22, 2000 at 12:51:53:

Nothing taken personally, Walt. I consider outside views and opinions ALL constructive when it comes to learning more about the insidious nature of this dysfunction.

Well - let's simply sum it up then (about the Nystatin issue, so we don't keep going back & forth): As Truss confirmed - If Nystatin produces symptoms (barring the very scarce and unlikely case of hypersensitivity to the drug), it's killing yeast, period.

As far as the central issue of LGS, is there/should there ever be concern that prolonged use of Nystatin could exacerbate or cause LGS (another one of the "theories" I hear about)???



Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida.

Posted by Walt Stoll on March 23, 2000 at 11:26:13:

In Reply to: Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida. posted by Tim on March 22, 2000 at 16:29:34:

Hi, Tim.

How would the Nystatin exacerbate the LGS?

Walt



Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida.

Posted by Tim on March 23, 2000 at 13:44:13:

In Reply to: Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida. posted by Walt Stoll on March 23, 2000 at 11:26:13:

Walt -

The theory of Nystatin causing the organism to mutate or burrow in deeper into the mucosa and cause increased permeability was just something I read that was on a candida forum. I will try to find the exact postings if you like & if it really matters. When you brought up the LGS, it just triggered my memory. In any case, Like Truss, I feel that's totally unfounded, but who knows.

But, you do agree (with Truss) that when Nystatin produces symptoms it's killing yeast?

Tim



Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida.

Posted by Walt Stoll on March 25, 2000 at 11:21:56:

In Reply to: Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida. posted by Tim on March 23, 2000 at 13:44:13:

Hi, Tim.

When ther is "die-off" symptoms the Nystatin is "killing yeast". However, I have only seen 2 cases where this was the actual thing that was causing the symptoms.

So far as the "incomplete cell-wall forms" of candida is concerned. The jury is still out on that one. I used a Liv-Cell apparatus in my office for years and the incomplete cell-wall forms can actually be seen with that dark-field instrument. I did not observe the problem, with increasing forms with the Nystatin, with any of the several thousand cases we treated over the 15 years I knew enough to treat this. Actually we actually routinely saw these forms disappear in anyone taking the Nystatin.

Walt



Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida.

Posted by Tim on March 25, 2000 at 14:28:17:

In Reply to: Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida. posted by Walt Stoll on March 25, 2000 at 11:21:56:

Walt -

When you said: "When there is "die-off" symptoms the Nystatin is "killing yeast". However, I have only seen 2 cases where this was the actual thing that was causing the symptoms."

What do you mean that you have only seen 2 cases where this was the actual thing that was causing the symptoms? Do you mean you've only seen 2 cases of die-off?

Have you ever noticed problems with patients relapsing or having problems when the brand of Nystatin was changed? Is there a specific brand you prefer & does the brand even make any difference in your experience?

Also - what do you feel is the most accurate test for diagnosing mercury toxicity? Colleagues have always mentioned the DMPS but I have some reservations after reading several articles about the side effects patients have suffered following the test.

Regards,

Tim




Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida.

Posted by Walt Stoll on March 27, 2000 at 12:18:43:

In Reply to: Re: NYSTATIN RESISTANCE? - Once & for all, time for the truth!!! (Misplaced effort?) Archive in candida. posted by Tim on March 25, 2000 at 14:28:17:

Hi, Tim.

First if all, I think that MANY symptoms have been called die-off that were not. People have trouble understanding that traces of dietary no-no's, which are causing withdrawal symptoms, are the cause of these symptoms instead of the die-off.

In every case but those 2, as soon as I took the time to figure out exactly what they were eating, their symptoms were gone in 3 days just by doing the diet perfectly. Even in THOSE 2, I have never been convinced that it was just because I could not find out what they were withdrawing from.

I HAVW seen people who would be hypersensitive to Nystatin of one brand and not to another. I have not seen people, who were not hypersensitive, who did better with one than they did with another. I think I used to use Lederle but I have heard that they have stopped making it.

See the archives about mercury and you will find the answer to your question as well as I could look it up. You will also find Hal Huggins # for more information. I am sorry that I do not have the information right at hand.

Walt



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