What is Candida Albicans?
Candida refers to yeasts that can cause infections. Candidaemia refers to candida in the bloodstream. Candida Albicans is a ground dwelling yeast. It normally is found living in the soil. However, as with many micro-organisms, candida is an opportunistic microbe, than is capable of exploiting a number of enviornments.
The human intestine is one such enviornment. Candida can reproduce by forming spores, which are highly resistant to stomach acid and bile. Since candida spores are almost everywhere, little wonder that a few candida spores on a piece of food eventually end up colonizing the intestines of the vast majority of human beings. For all practical purposes colonization by candida is unavoidable. Resistance is futile.
Symptoms include muscle cricks, constant pain, reoccuring head ache, aggressiveness, flinching, electric shocks, anger, anxiety, and fear.
My Battle With Candida Albicans
I am a 54 years old male. I have been under treatment for Candidiasis, which is a form of fungal infection. My naturopath doctor, Mr. Asano, who is also trained in Ayurveda and Chinese medicine, diagnosed me with Candida/Yeast Infeection in October 2000. It has taken more than sixteen months and I am on way to full cure from many chronic symptoms. I have attached few photographs of my vanishing eczema and dark circles around my eyes. Though two MDs, Dr. Orion Truss and William Crook have done groundbreaking work on the "Candida-Yeast Infection" almost twenty years ago, this form of Candidiasis is not generally recognized by modern medicine as a disease. Modern Medicine heavily relies on diagnostic tests and unfortunately, reliable test for detecting Candida overgrowth has not surfaced yet. Orion Truss, MD in his seminal work, The Missing Diagnosis, suggests that "the (candidiasis) diagnosis can only be based on the clinical picture (Truss, 34-35)." One of the reasons that my allopathic doctors in the US were not able to help me is the lack of diagnostic tests for Candida (Senerchia 15-17). I am thankful for the support of Dr. Haribhushan, MD, my physician brother in India, who supported me throughout in my recovery.
Candida is a fungal allergic infection of the gastro-intestinal and urinary tract. This disease affects many women and quite a few men. It is a disease that is exacerbated by wrong diet, undue stress and dozes of antibiotics. The symptoms of Candidiasis are broad and many – chronic fatigue, depression, hives, eczema, urinary tract infection, colitis, sinusitis, muscle ache, hemorrhoids, blurred vision, allergies etc. The various symptoms manifest differently for each patient and it is highly unusual that the two patients of Candidiasis will experience same symptoms. In fact, the same patient may experience varying symptoms over time.
I had various chronic symptoms – post nasal drip, sinusitis, dark circles around the eyes (allergy shiners), and recurrent urinary tract infections. Eczema (both dry and wet), fatigue and labile hypertension. Additionally, I had been noticing gradual degradation in my health - drowsiness, lethargy (depression), snoring due to excessive mucous in throat, lungs and sinuses, rectal itching, and erratic sleep pattern.
The treatment is simple and requires common sense and perseverance– eat healthy (whole grains, vegetables and fruits, sugar-less, yogurt), less stress (laugh and rest), take antifungals daily (neem-an Indian medicinal plant, safgool-psyllium, triphala- an Ayurvedic medicine, fresh chopped garlic, grape seed extract, chinese and homeopathic herbs, accupuncture), remove and flush toxins from the body (exercise, hot bath, enema, neti – an yogic method for nasal irrigation and sauna) and take vitamins and minerals (A, C, E, Zinc, cold pressed flax seed oil). It takes time – up to 2-3 years. Please watch for the die-off (Herximer’s) reaction and manage the intake and rotation of anti-fungals accordingly (Tips 144-148, Crook 35-38, ).
I was hoping that my treatment under Dr. Asano would not take more than six months. But it took longer than fifteen months. According to my naturopath, Dr. Asano, the Candida infection had become systemic and it had entered the blood stream in my case. Now, what is systemic Candida overgrowth?
Systemic Candida overgrowth occurs when Candida breaks the intestinal lining (see LGS) and enters the bloodstream. From there, it can travel to various parts of your body, call it a residence and multiply. The symptoms of systemic Candida overgrowth are : muscle aches, sore/stiff joints, fatigue, problems with particular organs, recurrent urinary tract infections, serious illnesses (Asthma, ADHD, Diabetes, MS, Arthritis, CFS, Fibromyalgia). If you're experiencing systemic symptoms, then you need some systemic anti-fungals (anti-fungals that enter your bloodstream in sufficient quantity to reach your joints and organs). The most mainstream doctors recognize systemic Candida overgrowth, but believe that only hardly immune-compromised persons (AIDS, cancer, organ transplant patients) can be affected.
As I learned about my disease through books and the internet, I was amazed to find out that many of my symptoms were related to Candida. Mainstream modern medicine has labeled these symptoms by different names but it has not been able to connect them and find a cure. Alternative cures may be possible for many of the ailments that the conventional medicine has declared incurable.
Why did I choose Alternate Medicine for Candida treatment?
My sinusitis and post-nasal drip had started almost forty years ago and the eczema on my leg appeared approximately fourteen years ago. I was very desperate, exhausted and itchy. I had been asking my MD doctor for a cure for the excessive mucous, post-nasal drip and eczema for the last ten to twelve years.I was examined by an ENT specialist in June 1996. The ENT specialist found mucous congestion areas in the throat and nasal passage and suggested that I should take allergy tests. The digram below shows the findings of the ENT doctor.
Also, I had four recurrences of the urinary tract infection since 1985. In the last two years, I had a recurrence of the urinary tract infection every year. I was referred to the urologist and I took renal ultrasound test and the tests came out OK. Of course, the usual course of the antibiotics relieved the urinary tract infection but other symptoms persisted. I was also told by my MD that there is no cure for eczema or post-nasal drip or dark circles under eyes, which he called "Allergy Shiners." According to MD, these symptoms can only be managed to provide temporary relief through cortisone ointments and anti-histamines. However, I believe that my MD is well qualified in the internal medicine branch. In the October 2000, I felt that I had exhausted all possibilities for a cure through modern medicine and I decided to seek the advice of a Chinese naturopath doctor, Dr. Asano.
Dr. Asano is Japanese and practices Chinese, Homeopahic and Ayurvedic medicine. Dr. Asano lived in Varanasi, India for five years and learnt Ayurveda there. I was told by Dr. Asano that he has a cure for me and he diagnosed my disease as Yeast infection (a form of Candidiasis).
What are the symptoms of Candida overgrowth?
Symptoms of Candida overgrowth are caused by toxins released. Not all listed symptoms will occur in all individuals. Usually, approximately 20 symptoms will be present.
Disfunctioning Glandular and Organ Symptoms: adrenal and thyroid gland malfunction, cold hands or feet, diabetes mellitus, hypoglycemia, hypothyroidism, impotence and low body temperature.
Gastrointestinal: bad breath (halitosis), bloating, coating on tongue (oral thrush), constipation, diarrhea, dry mouth, gas, heartburn, indigestion, inflammation, irritable bowel syndrome, obesity or/and excessive weight loss.
Psychological and Allergic: acne, blurred vision, bronchitis (recurrent), burning or tingling, chemical sensitivity, chest pain, coughing, earaches, hayfever, headaches, hives, muscle aches and tension, nasal congestion, nasal congestion, head tension, numbness, painful, swollen, stiff joints, shortness of breath, sinusitis and sore throats.
Emotional and Mental: ADD, ADHD, anxiety, depression, disorientation, drowsiness, fatigue, feelings of unreality, frequent mood swings hyperactivity, inability to concentrate, insomnia, irritability, joint pain, low energy, mental confusion, MS, muscle pain, muscle weakness, nervousness, poor memory and tingling and numbness.
Skin: Acne, anal itch, athlete's foot, dandruff, dermatitis, dermatitis, diaper rash, dry skin, eczema, excessive perspiration, facial rash, fungous infection of the nails, hives, impetigo, jock itch, lupus and psoriasis.
Genitourinary: Bladder infection (recurrent), burning on urination, cramps, cystitis (inflammation of the bladder), endometriosis (irregular or painful menstruation), fluid retention (edema), frequent urination, impotency, infertility, loss of sexual feelings, menstrual irregularities, painful intercourse, PMS, prostitis, recurrent yeast vaginitis, vaginal burning, itching or discharge.
What Causes Candida?:
The true causes of candida are not a mystery. They are also not the same for each individual person. Some people have candida due to a combination of causes. To begin with lets look at the true causes and discuss each.
1. ANTIBIOTICS: Antibiotics destroy both harmful and good bacteria. When antibiotics destroy friendly bacteria it gives the candida a chance to begin to multiply.
2. BIRTH CONTROL PILLS OR DEVICE: Birth control pills are mostly the hormone estrogen and supplemental estrogen in synthetic form has been found to promote yeast growth. The copper IUD is another possible yeast promoter. Excess copper can depress the adrenal, thyroid and immune systems of the body making it more difficult for the body to resist yeast.
3. EXCESSIVE STRESS: Stress causes the release of a hormone called Cortisol. Cortisol depresses the immune system and raises blood sugar; this leaves the body defenseless against the yeast elevation.
4. TAP WATER: Common tap water is high in chlorine, which destroys friendly intestinal bacteria.
5. PARASITES AND INTESTINAL WORMS: Some researchers have estimated that over 85% of all people in North America have parasites. Parasites destroy friendly bacteria in the intestines making yeast overgrowth possible.
6. CONSTIPATION: A constipated digestive tract is slow moving and becomes very alkaline, the environment where candida can flourish.
7. DRUGS AND ALCOHOL: Excess alcohol can allow yeast to grow, beer in particular, due to malt sugar content that can feed yeast cells very quickly. Drugs cause yeast overgrowth particularly if they disturb the digestive system.
8. HYPOTHYROID: The thyroid gland has an important effect on the immune system and helps the digestive system operate correctly. Lack of proper digestive secretions can cause reduction in bacteria. Constipation can also result.
9. HORMONAL IMBALANCE: An imbalance between estrogen and progesterone can be a factor in yeast overgrowth. Any upset in this balance can cause yeast overgrowth.
10. DIABETES: It is essential that the diabetes be addressed first and the blood sugar controlled. It is impossible to eliminate candida while the blood sugar is high, but there are specific anti-fungal herbs that have traditionally been used to lower blood sugar.
What is die-off (Herxheimer reaction)?
When you kill off a bunch of Candida at once, all of the toxins that are currently stored in them are released into your system all at once. As there are usually significant amount of toxins stored in Candida cells, these toxins when released will causes a temporary increase in yeast symptoms (often including new symptoms as new toxins are released), followed by a considerable lessening of symptoms. The technical name for this experience is a Herxheimer reaction ; it is more commonly referred to as "die-off" or "flare-up". This experience is similar to experience when Candida albicans is growing, such as when you have eaten a "forbidden" food. In both cases, Candida releases its toxins and it is often hard to differentiate whether you are killing it or feeding it. In order to tell the difference between die-off symptoms, reaction food and general yeast symptoms it is wise to keep a journal of what you eat and what anti-fungals you take, so when you get a change, you know which it's likely to be. As die-off is caused from anti-fungals it will usually last from few days to 2 weeks depending of what anti-fungal you use. As you kill almost all susceptible strains of Candida die-off effect will subside. Even if you don't get die-off it does not mean that Candida is eradicated from the body. It is possible that amount of Candida killed (toxins released) is to small to produce massive die-off. Then, you should either continue the same anti-fungal for few weeks to finish it off or even better, change to new anti-fungal. Also, the dosing of anti-fungals and their effectiveness can be established by observing die-off effect. The die-off effect of anti-fungal should not be intolerable, but you should feel die-off. If die-off effect is too strong, the dose of anti-fungals should be decreased. To minimize the effect of die-off.
You can reduce antifungal dosage (or even discontinue it) drink lots of water to flush away the dead yeast toxins. use hydrotherapies (like enemas) to flush away dead yeast toxins take Bentonite Clay or Psyllium.
There are two problems with the anti-fungals - Allergies and die-off reactions. Sometimes they are hard to tell apart. It is important to keep rotating the anti-fungals to avoid any allergic reactions When candida cells die, they suddenly release all of their poisons at once, making you feel far worse for a short time. That is called a Herxhiemer, or die off reaction. You can usually tell a die-off reaction from an allergy, since a die-off:
1.) leaves you feeling better than before it hit you,
2.) does not hit you worse if you take more of the stuff after you begin feeling better. Don't give up, either of these means it's working!"
My Treatment and Die-Off Reactions:
Change in the diet (no sugrar, less carbohydrate, more protein) combined with natural anti-fungal and various toxin flushing methods have been the path to cure from this infection for me. It has required patience, perseverance and faith. I now believe that one of the biggest challenge in the Candida treatment is the understanding of the "die-off reactions" and the rotation of anti-fungals. It is very easy for the patient to give up when the "die-off reaction" has started - thinking that the symptoms have worsened. When in reality, the patient may be getting better!
In my case, it seems that the initial source of the Candida infection was in my sinuses, which had manifested into excessive mucous in the throat, lungs and other organs. Initially the results were positive and quick. During the second month of my treatment, I found that my sleep became much better and the energy level shot up. However, sleep and energy levels went through a roller coaster ride later during severe "die-off" periods. I could notice that the flare up of the eczema in my legs was directly related to the "die-off."
The clearing of the mucous from the intestine and the lungs and throat was realtively faster but it still took nearly six months. The eczema in the mean time also got reduced by almost 70 percent. But the clearing of the mucous in the upper respiratory tract has been a much slower process. I have been very diligent in expelling the mucous from the lower and upper respiratory tract. Expelling the mucous out is very important - swallowing the mucous would cause more die-off reaction because it could be laden with candida toxins.
Except for the die-off periods, which depended upon various fungicide treatment, I found that the mucous build-up gradually decreased, post-nasal drip got better and eczema on my leg receded. This observation allowed me to persevere for months and I kept rotating the antifungals and the toxin flushing methods- hot sauna, hot bath, enema and aerobics. Exercise is very important for flushing the toxins.
Anti-fungals: Neem Powder, Psyllium Husk, Grape Seed Extract, Garlic, MSM, Goldenseal, Chinese Herbs, Homeopathic Medicine, Neem Oil and Tea Tree Oil for Neti.
Toxin Flushing Methods: Enema, Neti (nasal irrigation), Hot Water Bath with Epsom Salt, Hydrogen Peroxide Gargle, Dry and Wet Sauna, Walking, Tennis and Exercise
Diet: Mostly Whole Grains as breakfast or snack (Bhuja – puffed whole grains etc.), No sugar for the first six months, small amount of sugar in tea only later, yogurt, flax seed oil, vegetables, lentils, some rice, fruits and nuts.
Vitamins: A, C, E, Zinc and Aloe Vera Gel for Skin
It is important to introduce anti-fungals gradually and cautiously. I found that I was rather aggressive in introducing diluted "Neem oil" into the nostrils with a Neti pot. I found that strongest "die-off" reaction when I used a drop or two of Neem Oil in the nostrils. Next morning, the whole face became swollen and it seemed like I could be having allergic reactions. It took almost two weeks to subside. The skin with the dark circles under the eyes got drier and gradually dark color of the skin started to fade. Also, the eczema in my leg would flare up and itch badly. Of course, my eczema, sinus and post-nasal drip got better after each "die-off." I stopped Neem oil thinking that I might have become allergic to it and decided to try Tea Tree Oil. Again, a similar reaction happened but it was much less severe. As the toxins started to leave through the skin, rashes appeared and the face became grey and pale. According to the book, Ending Fatigue and Depression – A Patient;s Manual, "Facial rashes started to appear, my complexion turned grey due to the Candida toxins die-off (Nolan 15)." Of course, after few weeks , the facial skin became smooth and shiny. Therefore, gradual killing of yeast is better even if it takes a little longer to eliminate yeast infection from the system.
Status as of February 9, 2002
I have been intrigued by the relationship between the eczema on my left leg and the mucous in the sinuses. It seems as if they are directly corelated. Both eczema and sinus are getting bettter in complete unison, Eczema has almost vanished, the dark patches on the left leg are becoming lighter and the skin is becoming shiny and smooth. I donot have post nasal drip and the sinuses are very clear. The facial skin and complexion is getting better also. Itching in the legs and face have subsided almost completely. Dark circles under the eyes have faded greatly, energy level is much better. I do not experience any rectal itching now. I am able to get a good and deep sleep. I dream often now. Dreaming usually ocurs in deep sleep.
The labile hypertension is under accepted levels but I still take allopathic medication to control my blood pressure. According to the herbal experts, excessive mucous (catarrah) in the blood can elevate the blood pressure and the cure requires cleaning the internal mucous membranes, intestine and liver, which may take long time.
The question remains as to how long it takes to get well. The general rule is that it takes at least one month to heal from each year of the chronic Candida infection. According to the book, Ending Fatigue and Depression – A Patient;s Manual, "The absolute minimum time before being completely healthy is three months. The average treatment takes from six months to a year and a half. A smaller portion of people will take two to three years before being able to stop treatment and a very rare few will never be able to stop treatment (Nolan 79)."
What is the Lesson for Us?
According to Dr. Senerchia, MD " Far too many doctors are unaware of the modern epidemic of Candida infections that has spread across our country due to antibiotic overuse and abuse, ruining the health of hundreds of thousands of their patients" (Senerchia, intro IX). In the last one year, I have personally come across a few individuals where MDs may have potentially misdiagnosed, and possibly done harm to their patients by labeling them incurable diseases and medicating them with drugs that have serious side-effects.
Candida and Bowel Diseases incl. Crohn's Disease:
Some physicians maintain that candida is not related to IBS (Irritable Bowel Syndrome), and that the only people who are considered to be at risk for candidiasis include those whose immune system is repressed through illness or medication. However, as evidenced by the sheer amount of information and personal stories found on the Internet, there are many people who have apparently suffered from candidiasis and found relief through treatment. The debate will most likely continue for years to come as evidence on both sides of the issue is accumulated. However, for people who have gotten proper diagnosis and treatment for candidiasis and experienced a reduction of IBS symptoms - the evidence is clear. And at the end of the day, that's what matters.
Candida, according to antibody studies done at the Atkins Center, is involved in more than 80 percent of all cases of Crohn's and Colitis.
Candida & Depression
Patients may have heard many times from doctors that they are suffering from "neurotic anxiety syndrome" when they complain of depression, anxiety, recurring irritability, heartburn, indigestion, lethargy, extreme food and environmental allergies, acne, migraine headaches, reoccurring cystitis, or vaginal infections, premenstrual tension, or menstrual problems, all of which have not been identified with any disease entity. Yet recently, thanks to the pioneering work of Dr. C. Orian Truss of Birmingham AL, considerable progress has been made in understanding the origin of this symptom constellation in many individuals. The explanation is locked into understanding the life cycle of a symbiotic yeast becoming a parasite called Candida albicans.
Candida & Chronic Fatigue/Fibromylagia - Modern medicine labels Chronic Fatigue Syndrome (CFS) as a mysterious disease. In the U.S. outbreaks of CFS occurring within the same household, workplace, and community have been reported but most have not been confirmed by the Centers for Disease Control. A large British study of people with both diagnosed CFS and idiopathic chronic fatigue also found no evidence of infection as a direct cause of either condition but previous infections may play some role. Most cases of CFS occur sporadically, cropping up individually without appearing to be contagious, and there is no consistent evidence that CFS is spread through casual contact, such as shaking hands or coughing, or by intimate sexual contact. Well-designed studies of patients who met strict criteria for chronic fatigue syndrome and of patients with idiopathic chronic fatigue have also not found an increased incidence of any infections, including Lyme disease, candida ("yeast infection"), herpesvirus type 6 (HHV-6), human T cell lymphotropic (HTLVs), Epstein-Barr, measles, coxsackie B, cytomegalovirus, or parvovirus. Some researchers are suggesting that changes in normally harmless bacteria found in the intestine may play a role in the development of CFS symptoms."
Fibromyalgia causes prolonged fatigue and widespread muscle aches. A characteristic feature is the existence of at least 10 distinct sites of deep muscle tenderness that hurt when touched firmly; the sites include the side of the neck, the top of the shoulder blade, the outside of the upper buttock and hip joint, and the inside of the knee. Some patients with CFS exhibit similar tender pressure points. Recurrent sore throat, headache, low fever, and depression are also common symptoms of fibromyalgia. Like CFS, fibromyalgia is chronic and not curable; some, but not all, experts believe it is simply another variant of chronic fatigue syndrome, and one compared fibromyalgia to chronic fatigue as the same relationship as a migraine to a headache.
Candida and Family and Genetics Candidiasis is known as the "silent epidemic" of the 20th century, mainly caused by our diet and lifestyle. However, Candidiasis is a mildly contagious disease. Since it is not transmitted through casual contact, only the closest family members are likely to be affected. Spouses are especially prone to Candidiasis through the contact of sexual fluids. It is better and convenient to treat the whole family at once because diet restrictions are important for cure from the Candida overgrowth.
Many people are affected by Candidiasis, which can manifest itself in allergies. The role of genetics is not clear but could be a factor.
"Most allergies are inherited, which means they are passed on to children by their parents. People inherit a tendency to be allergic, although not to any specific allergen. If a child develops an allergy it is very likely that at least one of his or her parents has allergies.
"Actually, for many people, a yeast infection or a lack of the friendly bacteria can be established the moment you are born. Both friendly and unfriendly microorganisms are picked up at birth as a newborn baby passes through the birth canal of its mother.
If the mother is not adequately supplied with the friendly flora, her baby will also be lacking. If she should happen to have a yeast infection anywhere in her body, then the Candida or a predisposition to a yeast infection can be transferred at birth to the baby.
If the child is not breast-fed (mother's milk contains and supports the friendly flora to help the baby), Candida will begin to grow slowly throughout life. When you consider all the white flour and sugary candy children eat, you begin to wonder how we survive. This is how and when many adults created the foundation for a yeast problem."
The treatment for Candida may not be the panacea for everyone. However, the benefits of Candida treatment could be enormous based on my personal experience. I had been suffering from sinusitis and post nasal drip for the last thity-five to forty years. My eczema had persisted for the last twelve to fourteen years.The good news is that Candida has been a "Blessing in Disguise" for me. Now, I breathe better, I feel better, I eat better and I sleep better. Permanent cure from many chronic ailments is possible (Chattow 49). Hence, we need to give Candidiasis a serious consideration in these modern times.
It is important to note that Candida claims to manifest itself in a very broad range of symptoms. The symptoms vary from individual to individual and over time, yet not everyone might be suffering from Candidiasis.
According to another source, "Candida albicans infection or an extreme deficiency of friendly bacteria can result in the following symptoms: Acid Reflux, Acne, Adrenal, Allergies, Anti-Social, Asthma /Bronchitis, Bad Breath, Behavior, Bladder / Urinary Infections, Body Odor, Bone Loss, Bruise Easily, /Chemical, Chronic Fatigue, Coated Tongue, Cold & Shaky, Colds & Flu, Colitis, Constipation, Crohn's Disease, /Depression, Diarrhea, Dizziness, Dry Mouth & Eyes, Dry Skin & Itching,/Eczema, Edema, Endometriosis, Epstein Bar Virus, Excess Mucus, Eyesight Problems, /Fibromyalgia, Finger & Toenail, Food Cravings, Frequent Infections, Fungus, Gas & Bloating, /Hair Loss, Hay Fever, Headaches, Heart Irregularities, Heartburn, Hemorrhoids, High Blood Pressure, High Cholesterol, Hormonal Imbalance , Hyperactivity, /Immune Deficiency Syndrome, Indigestion, Inflammatory Problems, Insomnia, Interstitial Cystitis, Intestinal Pain, Iron Deficiency, Irritable Bowel Syndrome ,/Joint Pain,/Leaky Gut, Low Blood Sugar, Lupus-Type Symptoms,/Malabsorption, Menstrual Problems, Mineral Deficiency, Miscarriage, Mood Swings, Muscle Aches,/Nausea, No Sex Drive, Numbness, /Osteoporosis, Over or Under Weight, Over-All Bad Feeling, /PMS Symptoms, Poor Memory, Premature Aging Problems, Prostate Enlargement, Puffy Eyes,/ Respiratory, Rheumatoid Arthritis, Rosacea,/Sensitiveness, Skin Rashes, Snoring, Suicidal Tendencies, Thrush,Thrush & Receding Gum, Thyroid Weakness, Tingling Sensations, /Ulcers, /Vaginal Infections, Vitamin Deficiency.
Modern mainstream medicine has been reluctant to accept Candidiasis as a disease. Ayurveda, Chinese herbal medicine and acupuncture, Homeopathy, and yogic exercises (for example, Panchkarma - a yogic ritual for toxin cleansing), should be considered seriously as a complimentary or alternative method of cure from candida.
As a patient, I have immensely benefited from the contribution of other patients and doctors on the internet and through books. I am grateful for this. Similarly, I hope that others will get information and encouragement from this article. I sincerely hope that patients will become aware of Candidiasis as a disease, its symptoms and the cure -- in turn, they would inform and educate their friends and doctors.