Candida Overgrowth in Expats: Symptoms, Causes, and How to Get Relief

The Candida comeback: Why so many expats are struggling with yeast overgrowth

Increasing numbers of expats are experiencing health problems which may be connected to yeast overgrowth, commonly known as Candida. The increase in cases of Candida – sometimes referred to as the Candida comeback – appears to be linked to the lifestyle enjoyed by many expats: increased alcohol consumption, food rich in sugars and carbohydrates, and higher stress levels. In this article, we look into the causes and symptoms associated with Candida.

What is Candida / yeast overgrowth?

Candida albicans is a fungus. Whilst the word “fungus” often has negative connotations, Candida is actually a harmless fungus that lives in and on your body. Candida albicans is the most commonly occurring species of Candida yeast. It is a microscopic fungus and is typically present in small quantities on your skin, in your mouth and in your intestines. The healthy bacteria in your body help to keep the yeast in balance and prevent it from overgrowing. However, if something disrupts this balance, yeast overgrowth occurs and infections can develop, such as thrush. Although both uncomfortable and embarrassing, these infections are common and can be quickly and easily treated using antifungals from your doctor.

Do I have to do anything about Candida albicans?

Not normally, because if you are healthy, Candida albicans will not present a threat to your well-being. However, if you experience any symptoms of infection (see list below), be sure to contact your doctor immediately. In most cases, symptoms will decrease or disappear once treatment begins. It is important to complete the course of treatment as prescribed by your doctor in order to reduce the risk of the infection returning.

Types of Candida albicans infections (candidiasis)

Candida albicans can cause different types of infection, depending on where it affects your body. These types include:

• Cutaneous (skin) candidiasis: Yeast grows in the folds of your skin, such as under your breasts or your buttocks (nappy rash). This results in raised red patches.
• Candidal paronychia: Yeast collects in your nails or cuticles. This causes discolouration of the skin, accompanied by pain and swelling around your nails.
• Thrush: An overgrowth of yeast forms inside your mouth and throat. This causes raised white bumps that are both painful and irritating.
• Vaginal yeast infection: Yeast multiplies inside your vagina. This causes redness, itching and burning, accompanied by abnormal vaginal discharge.

Candida albicans symptoms

Normally, the presence of Candida albicans will not cause any symptoms whatsoever. Symptoms will only develop once an overgrowth of yeast occurs due to an imbalance of the healthy bacteria. Depending on the location of the infection, symptoms can vary considerably.

Mouth symptoms:

• Hot or burning tongue, coated tongue, scalloped tongue.
• Canker sores, blisters or mouth sores, bad breath, white or yellow coating on the tongue, oral thrush.
• Blocked salivary glands.

Stomach symptoms:

• Indigestion. Reflux.
• Heartburn. Here, some foods can be a significant trigger; these often include tomatoes, orange juice, chocolate, onions and garlic.
• Helicobacter pylori (H.pylori) stomach infection.
• Nausea may occur as a symptom, with certain foods or smells making some people more prone to mild nausea. This can affect the appetite.

Gut symptoms:

• Distended abdomen, bloating. One localised tender/painful spot (left or right side) might be a cause for concern.
• Bowel: gas, passing wind. Stomach cramps.
• Constipation/diarrhoea (long-term). Alternating bouts of constipation and diarrhoea, irregular bowel motions.
• Mucus in stools. The colour can range from white to yellowish. Tiny white strands in the stool.
• IBS (irritable bowel syndrome).
• Recurring “food poisoning” or similar gut infections. Underlying gut issues like leaky gut can make you more vulnerable to chronic infections.

Rectal symptoms:

• This may include haemorrhoids or rectal fissure.
• Rectal itching.

Nose, ear, throat, and lung symptoms:

• Itchy ears, scratchy throat. Coughing up phlegm in the morning (even as non-smoker).
• Mild to severe breathing problems. Congested nose, sinus infections and discharge. Itching or discomfort in the nasal or sinus areas (often misdiagnosed as allergies).
• Ear infections caused by Candida can result in itching, pain, and discharge.
• Oral thrush and throat infections (oropharyngeal candidiasis), typically appearing as white patches on the tongue or inner cheeks, causing discomfort or difficulty swallowing. Persistent sore throat. Altered sense of taste.
• Respiratory issues, including coughing, wheezing, and shortness of breath. In severe cases, pneumonia or bronchitis may develop. Gut microbes may affect not only digestion, but also immune and lung function.

Cravings:

• Cravings for sugar, sweets, chocolate, fizzy drinks, high-sugar fruit drinks, pasta, high-carb foods, alcohol, liquorice, and alcohol in the form of beer, wine or spirits.

Is Candida albicans contagious?

Generally speaking, yeast infections are not contagious. However, if your immune system has been weakened or you are taking certain medications, Candida albicans can spread from an infected person. If you are healthy, it is very unlikely that Candida albicans will spread to you.

Treating Candida albicans

As mentioned above, Candida albicans is a naturally occurring fungus that lives in and on your body – and you should not try to remove it. If, however, an imbalance has occurred and you have an infection, this can be treated using antifungal medication. Your doctor will prescribe the appropriate type of medication for your condition.

Antifungal medications are available in three main forms:

• Oral: This type of medicine is taken by mouth (tablet, liquid or lozenge).
• Topical. This type of medicine is applied directly to the affected area (creams or ointments).
• Intravenous (IV): This type of medicine is administered through a vein (in severe cases).

It is important to visit your doctor if you have symptoms which point towards a Candida albicans infection. Do not be embarrassed about being open and honest regarding the symptoms you are experiencing, as only then can your doctor provide you with the correct antifungal medication and the appropriate instructions for its use, which will then lead to the infection being cured and not returning. As mentioned earlier: Candida albicans infections are not uncommon and your doctor will know how to help. There is no need to be embarrassed!

A question often asked: Is Candida an STD or STI?

No, Candida albicans is not a sexually transmitted infection. As already stated, it is simply a type of yeast that is always in and on your body, but it can cause problems in the event of an imbalance in your healthy bacteria. Whilst the yeast balance could indeed change as a result of sexual activity, having sex does not cause an infection.

Why is the so-called “Candida comeback” occurring?

There are a number of factors attributed to the increase in Candida infections. The medical profession is not unanimous in its opinion on this subject, but Candida infections do often appear to be connected to lifestyle factors that coincide with the lifestyle of expats: increased alcohol consumption, a diet with large quantities of refined sugars and carbohydrates, and higher stress levels. Furthermore, cases of Candida infections increased during the COVID-19 pandemic; whether this was due to the additional strains on healthcare systems during this period and/or the increased use of certain medications remains unclear. In addition, factors such as weakened immune systems, prolonged hospital stays, and the use of medical devices can also increase susceptibility. Evidence suggests that antibiotics also play a role in the development of Candida infections.

What actually happens in the body in the event of Candida overgrowth?

As mentioned above, Candida albicans coexists harmlessly with beneficial bacteria if the microbiome is healthy. However, under certain conditions – such as gut dysbiosis (an imbalance in the gut flora), immune suppression, or high sugar intake – Candida can increase rapidly, thereby forming biofilms which can potentially weaken the gut lining and cause systemic symptoms. During overgrowth, Candida can produce ethanol and acetaldehyde internally; this leads to symptoms often associated with hangovers, fatigue and “brain fog” - even if alcohol has not been consumed. Autoimmune conditions are frequently confused with Candida overgrowth symptoms.

Are expats in Spain more at risk?

Candida is, of course, not something only expats can have problems with. However, certain lifestyle changes experienced by expats living in Spain can create an ideal environment for yeast overgrowth:

• Social drinking: regular wine, beer and aperitivo culture, accompanied by tapas.
• Relocation stress: coping with bureaucracy, language problems, social isolation.
• Local diet habits: Mediterranean food is often accompanied by refined bread, patatas fritas, sweet items such as churros, and sweetened granulated rice puddings or pastries.

Combined, these factors can upset your gut balance, suppress immunity, and feed yeast growth.

Alcohol

Alcohol is one of the most potent Candida contributors, as it:

• Feeds Candida directly - sugar and alcohol act as a yeast energy source.
• Suppresses the gut bacteria, enabling yeast to flourish.
• Encourages inflammation and gut permeability, facilitating systemic symptoms.

In Spain, with its relaxed social culture, expats often receive invitations for evening drinks. But even the occasional sangría, cava, cerveza, or vermouth can provide Candida with a consistent supply of fermentable sugars. Especially when combined with carbohydrate rich foods.

Stress

Moving to a foreign country often causes chronic emotional and psychological stress. Factors such as adjusting to a new culture, learning the language, finding work or housing, dealing with paperwork in Spanish and building new social circles are not always easy to deal with. Stress:

• Raises cortisol, which in turn increases blood sugar.
• Impairs the immune function, leaving fewer defences against microbial imbalance.
• Disturbs gut movement and increases intestinal permeability (“leaky gut”).

It has been proven that chronic stress significantly increases the risk for fungal and bacterial overgrowth. Hidden food triggers and gut issues often worsen under stress.

The diet in Spain

Although Spain is renowned for olive oil, fresh produce and fish, the national diet also includes large quantities of refined carbohydrates and sweets:

• White bread and baguette-style rolls, often served at every meal.
• Pastries and sweets: churros (with molten chocolate), milk rice, etc.
• After-dinner desserts. Cafés offering cakes and pastries. Sweetened coffee with milk.

One of the major drivers of yeast overgrowth is a diet high in sugar and refined carbs. Candida positively thrives on glucose and maltose; if the diet contains refined starches and sweet treats on a regular basis, then the yeast is provided with a steady supply of “fuel”. Frequent visits to cafés and bars, together with tapas dinners and social events, mean that the sugar intake is often significantly increased. Reducing sugars and boosting fibre can aid gut repair and cholesterol control.

Combined effects

When alcohol, stress, and high sugar/carbohydrate intake are combined, they result in a kind of “perfect storm”:

• Alcohol reduces gut flora and supplies sugar.
• Stress lowers immune surveillance and raises blood sugar.
• Sugar from food and drink provides Candida with direct “fuel” and slows digestion, promoting dysbiosis (imbalance in the gut flora).

In Spain, a typical – and very enjoyable! – evening for an expat might include bread, wine, tapas and desserts. What may feel like a Mediterranean dream can, however, quickly turn into a nightmare of imbalanced gut flora and yeast overgrowth if not enjoyed with caution.

Lifestyle adjustments

For expats who suspect they have Candida overgrowth, the following lifestyle adjustments are commonly recommended (but they do not replace a visit to the doctor!):

• Reduce or eliminate alcohol – at least temporarily. Even fermented foods such as kombucha and yoghurt may feed Candida during active overgrowth phases.
• Reduce refined-sugar and processed-starch intake – replace with low-sugar fruits (berries), whole grains and vegetables.
• Manage stress – through mindfulness, yoga, regular rest and hobbies. This can reduce cortisol spikes. Natural strategies for stress reduction may support gut healing too.
• Support your gut microbiota through probiotics (e.g. kefir, unsweetened yoghurt, sauerkraut) and prebiotic fibre from onions, leeks, and greens.
• Make sure you stay hydrated and consume a good fibre intake in order to regulate your bowel movements and avoid constipation.
• Intermittent fasting or restricted eating window: Research suggests that periods of fasting can reduce inflammation and “starve” Candida, although this effect varies from person to person. Parasites and Candida may overlap in symptoms, but need different approaches.

Once your gut flora is healthy again, you can try slowly re-introducing items to your diet that you have been leaving out. If the problems flare up again, you know what the reason is.

Practical tips for expats in Spain

• Choose wine instead of sweet cocktails, and drink it with food in order to reduce the sugar impact.
• Enjoy tapas meals as occasional outings, not as a regular occurrence. Place the focus of home cooking on fresh fish, vegetables, legumes, and olive oil.
• For dessert, enjoy fruit or Greek yoghurt with berries. Gut imbalances can affect more than digestion — including reproductive health.
• Find a way to relieve stress: join hiking or language exchange groups, explore arts or music.
• Stay active: daily walks, cycling or yoga can support microbiome resilience.
• Consult a doctor: if symptoms are persistent, speak to a doctor before embarking on strict elimination diets.

To summarise all this information: The so called “Candida comeback” among expats in Spain is probably due to a combination of social alcohol use, dietary sugar, and relocation stress. Although the scientific debate has by no means reached a conclusion, many sufferers are able to improve their quality of life through lifestyle adjustments centred on less sugar, reduced alcohol, and better stress management.

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