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Comment by galangalalgol | Hacker News Reader

Is there any downside to periodically taking strong antifungals? We don't have beneficial fungi do we? I have been considering a dose of ivermectin twice a year. Studies hav correlates it with a strong anti cancer effect.

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This article [1] by Carl Zimmer discusses the topic.

It doesn't offer a conclusive answer to your questions, but makes the point that there could well be a beneficial role for fungi in the body that we currently know little about as it hasn't been researched in much depth.

I've personally had cause to research the human microbiome very deeply (i.e., as deeply as a layperson reasonably can) in the past 10+ years, and whilst the idea of eradicating all fungi has seemed compelling at times, I'm now much more on the side of taking moderate steps to keep things in balance.

Evolution and complex systems being what they are, it's unlikely that you could completely remove one component of the system without causing unintended negative consequences.

[1] https://www.nationalgeographic.com/science/phenomena/2013/05...

One thing fungi are generally good at is regulating bacteria. So that might end up being the beneficial role. However, it would have to be very specific fungi to survive within the body at all yet not damage the body, and likely also respond to and be suppressed by specific regulators that the body itself is producing.

Saccharomyces boulardii (“Brewer’s/baker’s yeast”) seems to be one such strain.

It is commonly taken therapeutically to keep other fungi and bacteria under control.

https://en.wikipedia.org/wiki/Saccharomyces_boulardii

Most, perhaps all antifungal, and in particular the most common, he azols, clear through the CY P450 pathway in your liver, unfortunately a very important pathway. Fungal diseases are hard to treat in part because doses high enough to be efficacious can lead to liver failure.

I would be wary of gratuitous use of antifungals (and I am a developer of an antifungal treatment that entered clinical trials). I would use an anti-dandruff shampoo if I had that problem but that’s about my limit.

Does this apply only to oral pharmaceutical antifungals? Or does it also apply to topical ones like clotrimazole for yeast, or food based oral antifungals like garlic?

At least in the context of toenail fungus, the topical treatments avoid risk to your liver (but generally don't work because it's hard to penetrate the nail and nail bed). However, even assuming a carcinogenic role for fungus, topical treatments are very unlikely to be useful for preventing internal cancers like pancreatic cancer.

Your dermis is designed to keep stuff out so though some of the topical will enter your system the amount is likely to be negligible (note: I am not a physician!!). Anyway topicals are used to treat fungi that attack dermal and nail tissue (e.g. tinia mentagrophytes or tinea pedis) so the whole point of using them is that you're applying the drug to the invader. This is why dandruff shampoo supposedly works.

I wouldn't worry about eating garlic although I haven't seen any studies suggesting it might actually be efficacious. But it is delicious!

Thanks! That's what I figured about topicals. As for foods, I guess the question would have been better framed as IF a food has any antifungal effect, would it thus necessarily also stress the liver? Or is that merely a common property of anti-fungal meds so far, but not a property of things that kill fungus per se.

Just curious, not trying to argue with you at all, but does that mean you’d discourage the occasional consumption of raw garlic (3-4 cloves)? I eat probably a few cloves of garlic whenever I eat Korean BBQ which is probably at least once or twice a month.

I haven't seen any study even suggesting that garlic might have any antifungal effect. And I find raw garlic too sharp, though I love it cooked various ways. But if it gives you pleasure why not?

That would gradually recruit antifungal-resistant yeasts, which can be very problematic (see Candida Auris which is thought to be the result of antifungal pressure in intensive agriculture).

re. beneficial fungi, AFAIK there are no known species that are part of our natural microbiota, but there may be unknown benefits. S. Boulardii supplements are know to help deal with gut flora disruptions like infections or antibiotic treatments.

S. Boulardii seemed to help me. I had a period of about a year with Crohn’s-like symptoms. I tried a lot of remedies, S. Boulardii did seem to help.

Here is another point to consider: If you were growing say Shiitake mushrooms on a container, a "bad" or potential unknown fungus might move in first to it and out-compete with your crop and thereby ruin your attempt.

But if your Shiitake mushrooms took hold and established a strong and healthy foothold the other mushrooms/spores/fungi will not be able to "move" in on after the fact.

So if you took this to a human perhaps the "good" fungus needs to be healthy and well colonized to prevent other random things from trying to grow in areas they shouldn't be in.

But I don't want shiitake mushrooms in my pancreas!

Why not?

How do you know until you try.......???

This is the same thing as the gut microbiome.. You need healthy bacteria and now fungi in your digestive system.

Incidentally, many mushrooms have profound anti-cancer properties. Shiitake is one of them.

That sounds quite intriguing, could you link to some of the papers on this topic as I'd be interested to read further.

I think that kind of reasoning is akin to saying we should eat pesticides because there aren’t beneficial pests in our bodies..

I did take an antifungal while sick, two actually. The first one made me break out in hives and the second one was a bit dehydrating (also couldn’t drink alcohol while on it). Would not recommend unless it’s necessary.

Having drunk alcohol on terbinafine because it was July 4 and I was an idiot I wouldn’t recommend the experience

They usually aren't perfectly well targeted.

https://en.wikipedia.org/wiki/Terbinafine#Side_effects

Ivermectin apparently works directly on tumors, it isn't an antifungal...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835698/

Its an anti-helminth. Dewormer.

Is there any downside to periodically taking strong antifungals?

I type on computers for a living but I think in general everything in your body is in balance. For example, if you remove bacteria via an antibiotic you can get a fungal infection. It stands to reason that if you remove fungi via an antifungal the reduced competition for resources could cause an overgrowth of bacteria.

From the article

“But it’s probably too soon to add broad spectrum antifungals, many of which have lots of side effects, to cancer treatment regimens, even in experimental settings.”

The article says there are lots of side effects, but anti-fungals are pretty commonly prescribed for things like toe-nail fungus and yeast infections. Liver function needs to be monitored.

And yes, I'm sure there are likely beneficial fungi that live on/in humans. While beneficial bacteria have been studied for years now, we just don't know as much about beneficial fungi.

Amphotericin B is really bad news ("Amphoterrible").

Ivermectine is for killing heartworms in dogs, right? Is it also an antifungal?

Aside from usage in many other beasts beyond dogs, ivermectin has a fairly wide and possibly growing range of applications, eg used externally to treat rosacea, internally for river blindness, etc. It has anthelmintic effects on many roundworms, but not flatworms. It's an acaricide and generally effective in treating scabies; also lice and bedbugs. Definitely keep pet spiders away from ivermectin! I've seen nothing (yet) indicating antifungal properties. Anyone considering self administration (a commenter somewhere above) should note the hepatotoxicity of the drug.

Edit note: I am pretty sure ivermectin is the active ingredient in Revolution, an extremely popular medicine for dogs... and cats, combatting both heartworm and fleas and maybe more.

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