Parasites are a lot more common than most people realize, affecting a huge number of people worldwide. The good news is that many parasitic infections are asymptomatic, or the symptoms are short-lived and resolve on their own without any treatment. The bad news is that parasites like Giardia and several others can leave you with long-term symptoms like bloating, nausea, burping, and fatigue. Figuring out which parasites are actually causing the symptoms and how to treat them can be challenging. In this episode I cover the trials and tribulations of arriving at the right diagnosis in one of my patients with chronic GI symptoms who believed a parasite was to blame.
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Conventional medicine practitioners think parasites are rare; alternative medicine practitioners think they’re common. The truth is somewhere in the middle.
On today’s show: I want to tell you about a patient I saw several years ago. From the beginning Lucy was convinced about what was going on. She walked in to her 1st appointment with me and said: “I have a parasite, and you have to find it and fix it.” Lucy had seen several gastroenterologists before me, and reading between the lines of their notes in her medical records, I could tell they thought she was a little bit intense. And Lucy was a little bit intense, and I would have been, too, if I had symptoms that no one could explain and that weren’t getting any better. She was extremely bloated, she had upper abdominal pain, nausea, what she described as “weird” stools, and she also complained of feeling tired all the time.
The first gastroenterologist Lucy saw did an upper endoscopy, looking for signs of acid reflux. The exam was normal, but they went ahead and put her on acid blockers for a month. No response. In fact she might have felt a little worse on the proton pump inhibitor – the acid blocker. Next step: stool studies for ova and parasites. We look for ova – the parasite eggs – because sometimes we aren’t able to detect the adult parasite, but we can find the eggs. The first gastroenterologist that Lucy saw ordered a stool test for ova and parasites that came back negative, but when I asked Lucy how many jars of stool she had sent off for that test, she told me just one. This is important because the probability of finding a parasite increases from about 60% with a single specimen to more than 95% when 3 specimens are examined. So I asked Lucy to use a popsicle stick to scrape her stool into 3 different jars and send it off to a specialty lab in Arizona with a really good track record for diagnosing parasites.
Now, when it comes to labs that test for parasites, we have to apply the Goldilocks principle. A lot of commercial labs just don’t spend the time and effort and aren’t sensitive enough, so they miss a lot of the less common parasites. And then you have the direct to consumer labs that are all over the internet and they tend to over diagnose and are frequently reporting normal organisms in the stool as pathogens. So really what we’re looking for is a lab that is sensitive enough to detect even low levels of problematic organisms, but not so overly sensitive that they’re misdiagnosing normal gut organisms as parasites.
My super reliable parasite testing lab found no evidence of a parasite in Lucy’s stool. No eggs, no worms, nothing. Since her stool was negative, I decided it was time to take a look inside, so I did a colonoscopy. I took multiple biopsies in every segment of her colon to check for microscopic evidence of inflammation. But those biopsies also came back normal. So I thought, OK, we’ve looked at her upper digestive tract and we’ve looked at her lower digestive tract, but we haven’t looked in between at her small intestine. It can be hard to reach all twenty feet of small intestine – that’s the part of the digestive tract sandwiched between the stomach and colon. It’s too long to completely examine with a traditional endoscope, but you can get a good look at it with something called a video capsule endoscope—a tiny capsule that has a camera, light source, transmitter, semiconductor, and a battery—all in a pill the size of a large vitamin that’s swallowed and then flushed down the toilet when it comes out the other end. The video capsule endoscope takes thousands of images that are compressed into a video.
Lucy’s video showed image after image of normal small intestine. She had now had her entire digestive tract examined, from her mouth to her anus, and it all looked completely normal. So then I started to think…hmmm, maybe the problem is inside her abdomen but outside her intestines. So I ordered a CAT scan of her abdomen. Which showed normal abdominal organs. Nothing unusual whatsoever.
Then I thought OK, the organs LOOK normal, but maybe they’re not functioning normally, so I ordered a scan to check out her gallbladder function. A malfunctioning gallbladder can definitely cause bloating, nausea, abdominal pain, and weird stools. When that came back normal, I ordered a gastric emptying study: a test where they give you radio-labeled food to eat and then scan over your stomach to see how long it takes to empty. If a significant percentage of the meal is still in your stomach at the end of the test, that’s considered diagnostic for delayed emptying, a condition called gastroparesis, that can also cause bloating, pain, and nausea. That was normal, too.
Next step: I asked Lucy to make a bunch of dietary changes: gluten-free, dairy-free, no refined sugar, fructose-free. She tried it all – but there was still no change in her symptoms. During a follow-up appointment to go over all the tests, Lucy pulled out some photographs of her stool. I have an album on my phone called “poo pics”. Images of my stool – especially the big luscious ones, my daughter’s when she was little (she rescinded permission for that a long time ago), patient’s stools, random strangers who send me pictures of their stool. It is amazing all the different permutations of what stool can look like and also how much you can learn from looking at someone’s stool. It’s kind of like reading tea leaves.
In the pictures there was an oily sheen to Lucy’s poo, and she mentioned that sometimes some of her stools floated. Now, oily floating stools are a classic sign of pancreatic disease, but she didn’t have any reason for her pancreas not to be working properly – she wasn’t a drinker; she didn’t have gallstones; she wasn’t on any medications that can affect the pancreas – but her stool and her symptoms fit the bill: oily-looking, foul-smelling stools that float, abdominal pain, bloating, and low-grade nausea—all symptoms consistent with a diagnosis of pancreatic insufficiency. So I gave Lucy a prescription for pancreatic replacement enzymes, thinking maybe I had finally cracked the case. Lucy took the pancreatic replacement enzymes religiously with each meal. And after six weeks, there was no difference whatsoever.
At a total loss for what to do next, I asked Lucy to send one final set of stool specimens to the lab of a local infectious disease specialist who had a lot of expertise diagnosing parasites. And this time, we finally had an answer. Lucy’s stool was positive for Cyclospora, a tiny one-celled organism that can be spread through exposure to contaminated food or water. Cyclospora usually causes diarrhea that can persist for several weeks. Additional symptoms include bloating, low-grade fever, abdominal cramping, poor appetite, weight loss, increased flatulence, nausea, vomiting, and fat malabsorption that results in oily, floating stools.
Lucy finally got an answer not because of my amazing diagnostic skills (it certainly took me long enough), but because we both believed that something was wrong and were willing to roll up our sleeves and find it. Parasites can live in the body undetected for years and, in addition to causing bloating, can create a wide range of problems like diarrhea, rectal itching, blood or mucus in the stool, low-grade fever, body aches, anemia, fat malabsorption, joint pain, teeth grinding, gallbladder dysfunction, and even neurological symptoms.
Parasites are a lot more common than most people realize, affecting a huge number of people worldwide and according to the CDC, up to a third of the population in the United States. Although many parasites are harmless and don’t cause any symptoms at all, if you’re having symptoms and think you may have a parasite, make sure your specimens are being sent to a reputable lab that has a good track record for parasite diagnosis. If the first test doesn’t show anything and you’re still convinced, get a second opinion somewhere else, like we did in Lucy’s case. But equally important, be wary of those labs that misdiagnose everyone with a parasite – and are also quick to sell you a cure.
Tapeworms, roundworms (also known as nematodes), and protozoa infect the human digestive tract. They range in size from microscopic to several feet long and can stay in the intestines or invade other distant organs. And again, some of these parasites are harmless species that don’t lead to any problems, whereas others can cause acute and chronic symptoms.
Most Common Intestinal Parasites in the United States
- Enterobius vermicularis (pinworm)
- Giardia lamblia (giardia)
- Ancylostoma duodenale (Old World hookworm)
- Necator americanus (New World hookworm)
- Entamoeba histolytica (amebiasis)
Most Common Intestinal Parasites Worldwide
- Ascaris lumbricoides (roundworm)
- Hookworm
- Trichuris trichiuria (whipworm)
- Giardia intestinalis
- Strongyloides stercoralis (threadworm)
The good news is that that many parasitic infections are asymptomatic, or the symptoms are short-lived and resolve on their own without any treatment. The bad news is that parasites like giardia and several others can leave you with long-term symptoms, because they can be difficult to eradicate and some of the symptoms may continue even after the parasite is dead and out of your body. Symptoms like bloating, low-grade nausea, burping, and fatigue can sometimes become chronic. Figuring out which parasites are actually causing the symptoms and how to treat them can be challenging.
In the medical literature, for example, Blastocystis hominis is often described as a harmless pathogen that doesn’t need to be treated, but alternative medicine practitioners frequently recommend therapy. And to make things even more confusing, some studies suggest that finding Blastocystis in the stool is actually a marker for increased bacterial diversity and a healthy microbiome.
Gutbliss Solutions for Parasites
If you’re exposed to a parasite, the likelihood of whether it’s going to set up shop in your digestive tract and cause symptoms is, like all other types of infection – bacterial, viral, fungal – related in part to how healthy your immune system is. The overarching theme in my 4th book, The Anti-Viral Gut was this concept that it’s less about the potency of the pathogen and more about the health of the host. Exposure does not have automatically lead to infection and infection does not automatically lead to chronic symptoms. So, here is some general advice for being a healthy host that can help you avoid parasitic infestation:
· Eat a healthy high-fiber diet, plenty of rest and exercise, limiting your exposure to chemicals and other toxins – that’s all part of creating a healthy immune system and that can help prevent parasites from becoming a chronic problem.
· Just like most pathogenic bacteria, parasites have a sweet tooth, so limit starchy, sugary foods is also important.
· Maintain healthy levels of good bacteria in your gut by avoiding unnecessary antibiotics will also help to discourage growth of parasites.
· A daily tablespoon of ground psyllium husk powder is like a broom that sweeps debris out of the intestines and can help to remove parasite eggs that may be attempting to make a home.
· Eat foods rich in vitamin A precursors, such as carrots and sweet potatoes, can help prevent parasitic larvae from penetrating, and raw garlic also has antiparasitic qualities.
· Parasites can be transmitted from dogs and other pets, so make sure yours are regularly checked for worms and that their feces are properly disposed of. You also need to be on the lookout for whether your pet might be eating the infected stool of other animals, a practice that’s not uncommon among puppies. To avoid coming into contact with infected stool, don’t walk barefoot where animals have been pooing.
· Strict hand washing and avoiding raw and undercooked meat are also important preventive tactics.
· As much as I love them, salad bars can also be opportunities for contamination of food. One University of California study secretly observed a salad bar and found that over half the diners were in serious violation of the rules, using their fingers to sample the food and committing other hygiene transgressions.
I want to leave you with 3 takeaways about parasites in the digestive tract:
1. If you think you have a parasite, it’s always better to get diagnosed and figure out if you really do, and, if so, which specific one. The treatments can differ dramatically, from single-dose over-the-counter cures to weeks of prescription medication. There are lots of natural remedies, too, including things that may already be in your kitchen, like garlic, black walnuts, papaya seeds, and cloves. But there are some natural remedies you have to be careful with, like wormwood tea, which is effective against many parasites and can be brewed at home, but also has some worrisome side effects, including sleep disturbances and possible organ damage.
2. In the absence of a diagnosis, beware of signing up for Internet cures that may or may not work and could have undesirable side effects.
3. Parasites are more common than many people realize and can cause a lot of different symptoms. A healthy immune system, which starts with a high-fiber, low sugar diet, is still one of your best defenses for preventing and eliminating these uninvited guests.
So that’s it for this episode of the Gutbliss Podcast on parasites.
Coming up next week on the Gutbliss podcast – I’m going to answer some questions from our listeners. If you’d like to submit a question for me to answer on the podcast, use the contact page on gutbliss.com. You can send a written question; an audio file or even a video – I’d love to hear from you!
