When I told someone the other day what the subject matter of this months newsletter was they said “Yeuuw (or some similar noise), Kate you can’t write about that, its disgusting, no one will want to read it”! However here I am writing this month about the apparently disgusting subject of parasites! Before you all go running off into the hills… this is an important topic. As parasites can effect all of us at one time or another you need to be informed as to what they are, what symptoms they cause, and whether they are effecting someone in your family as they are far more prevalent than you think. (and as I write this newsletter Cheryl Cole has hit the headlines with a bad bout of malaria even after talking anti-malarials).

In my clinic, parasites can account for up to 20% of IBS disorders and can go undiagnosed for years. The symptoms they create are varied which makes diagnosis difficult; these can include; fatigue, reactive arthritis, bloating, constipation, diarrhoea, gas, indigestion, nausea, nervousness and insomnia to name but a few. They are so often over looked as the cause of disease states.

Since the introduction of budget airlines many more people are travelling abroad on holiday to places like Florida, Turkey, India, Egypt etc and many of us will get a bout of travellers diarrhoea. Often when patients come to see me with symptoms it is after a holiday like this or having lived abroad. However this is just half the picture as I also see many clients who live and work with people in enclosed large environments e.g. hospitals, schools and nursing homes or live on farms or keep animals.

After an initial acute infection you can get a raised eisonphilia count (part of the white blood cells). However taking one stool sample and sending it down to your local hospital often concludes in a negative test. The reason for this is varied, however three stool samples need to be taken to get a real “show” of the parasite and often the lesser known parasites are not tested for at this level and specialist laboratories are needed. As nutritionists we use laboratories that take three stool samples over three days and more often than not there will be a positive diagnosis where the local laboratory has not found one.

With no initial acute infection, a patient can be ill for years with vague and varying symptoms but usually after a consultation they will say “I haven’t been well since I went to Africa in the 1970’s, and there is the clue that needs to be followed up.

What is also interesting to observe is those patients who suffer with reactive arthritis, as certain types of parasites can cause similar symptoms. As we are always trying to find the cause of disease, a parasite would be one of the first ports of call for me to look at, as many of these protozoa cause these symptoms and no amount of anti inflammatory drugs will cure the problem, rather just help with the symptoms.

If you have a parasite infection, it’s better to get an early diagnosis, and where necessary, a course of antibiotics. Crucially it is what you do after with diet etc that can make a huge difference to how you recover.

What exactly is a parasite?

A parasite is an organism that benefit’s at the expense of the host. They are usually much smaller than their host and reproduce more quickly and in greater number than the host. Classic examples would be tapeworms and flukes. They are organism that live on or in other organisms from which they obtain nutrients to live and cause harm in the process. Its name comes from the Greek word para that means beside, and sitos, which means food.

What I’m talking about here is intestinal parasites. It is estimated that 200 million people worldwide are infected with intestinal parasites. There can be over 100 different types of parasites and worms living in human bodies. Some are microscopic in size while others can be seen quite easily. These common organisms can be found everywhere in our environment, in the air we breath, in the water we drink, or in the food we eat. Most parasites require some host to complete their life cycle. Animals can also serve as the host. The parasite will vary in size from one-thousandth of one micron to whale tapeworms one hundred feet long (ok, you can you can go yeeeuw now!)

Parasites and worms can invade your body through food and water intake, through transmitting agents (like mosquito), sexual conduct or through the nose and skin. Human intestinal parasites can be present in any person and at any age. Most doctors are not trained to recognize the symptoms of parasitic infections. The only way to avoid the problems associated with parasite infections is by educating yourself.

Types of parasite

There are 3200 varieties of parasites divided into four major categories, Protozoa, Trematoda, Cestoda and Nematoda. Here are some of them most commonly found:

Roundworms: look similar to an earthworm and can produce 200,000 eggs daily. Approximately 1,000 million people are infected, making it the most common infection worldwide. The most frequent symptom from roundworms is upper abdominal discomfort. Other symptoms are asthma, eye pain, insomnia, and rashes due to the secretions of waste products from the worms. Large numbers can cause blockages in the intestinal tract, haemorrhage when penetrating the intestinal wall, appendicitis, peritonitis, abscesses in the liver, hemorrhagic pancreatitis, loss of appetite, and insufficient absorption of digested foods. Adults grow to 15 inches long.

Hookworms: the larvae penetrate the skin. When hookworms reach adulthood, they can sap the victim’s strength, vitality and overall well-being. Young worms use their teeth to burrow through the intestinal wall and feed on your blood. Symptoms from hookworm are iron deficiency, abdominal pain, loss of appetite, craving to eat soil, protein deficiency, dry skin and hair, skin irritations, oedema, distended abdomen, stunted growth and delayed puberty. Length: ½ inch long.

Pinworms: these can infect one in five children. Symptoms are itching and irritation of the anus or vagina, digestive disorders, insomnia, irritability or nervousness. Once airborne, the eggs can survive about two days anywhere in your living environment.
Worldwide, about 500 million people are infected with pinworms. The worm is white and can grow to about half inch in length.

Whipworms: infections are estimated at several hundred million worldwide. Symptoms of whipworms are bloody stools, pain in the lower abdomen, weight loss, rectal prolapse, nausea and anaemia. Length: 1 to 2 inches.

Giardia: is the most prevalent intestinal parasite in humans and found in drinking water. Giardia resides in the smaller intestine and at times in the gall bladder. Millions of these giardia organisms will coat the intestinal walls, preventing the absorption of nutrients and later causing illness. Symptoms are mild to moderate abdominal cramps, intestinal gas, light colored stools, bad absorption, weakness, chills, stomach bloating and diarrhea.

Tapeworms: inc. bladder worms, pork tapeworms, broad fish, dog tapeworms, dwarf and rat tapeworms. Broad fish tapeworms may grow to 35 feet long and live ten years inside the persons intestines. Some tapeworms can lay as many as one million eggs per day. Their bodies are in separate segments with hooks and suction cups on their skull.

Flukes: These include flatworms, bladder, blood, liver, lung, kidney and intestinal flukes. Human infections of flukes are in excess of 250 million people worldwide. They can cause severe disease of the gastrointestinal tract, bladder, liver and destroy blood cells. Size varies from 1 to 2.5 cm in length.

What are the symptoms of a parasite infection?

Allergies. Many allergies are caused by worm infections. Tissue becomes inflamed and reactions to foods are the result when eosinophils (white blood cells) are increased due to them. Extreme skin rashes with blisters and food allergies or sensitivities may result.

Anaemia. Worms leach nutrients from bodies causing anaemia. When they are present in large numbers, they can create enough blood loss to cause anaemia or iron deficiency in some people.

Constipation. Some worms can obstruct certain organs like the colon causing constipation, liver and the bile duct.

Diarrhoea. Often as the result of the initial infection.

Fatigue. Symptoms include tiredness, flu-like symptoms, apathy, depression and lack of concentration.

Gas and Stomach Bloating. Some parasites live in the upper intestine, which can cause both gas and stomach bloating.

Immune Dysfunction. Parasites can depress the immune system by decreasing immunoglobulin.

Nervousness. The waste products from parasites can irritate the nervous system, resulting in anxiety and restlessness.

Other Signs of Parasites in Children

Blisters appear on the inside of the lower lip, restlessness and grinding of the teeth at night, dark circles under the eyes, hyperactive, bed wetting, headaches, sensitive to light and itchy bum.

How do I get tested?

Initially see your GP, and ask for three stool samples to be taken not one. Your local hospital will pick up many of the bacteria’s like salmonella, campylobacter, worms, e. coli etc but will often not test for many of the parasites listed below. As a referral to a specialist hospital like the London School of Tropical Diseases could take a while, I would suggest investing in a private stool test. However, these are expensive and can start from £100. However you can be assured of an accurate result. If you would like to discuss this with me please call me on 01323 737814 or email at katenut@aol.com.

How do I get rid of them?

Once proven that you have an infection, you have two choices, one is taking antibiotics, which can work well and the other is a more natural method. I usually suggest to my patients to start with antibiotics if they can handle them. For those who find antibiotics difficult, we use herbs, however it can take a couple of attempts to really rid yourself of parasites.

Does what you eat make a difference?

Yes and No. A high carbohydrate diet, low in protein, and high in alkaline foods has been found to make parasitic infections worse. Sugar should also be avoided because parasites thrive on it. Keep your bowels open daily and do not get constipated and take a good probiotic as this will help raise the immune system and help with any inflammation.

How can I prevent catching them in the first place?

Wash all fruits and vegetables.

Scrape off the wax substance on the outer surface on any fruit or vegetable with knife before washing. Anything with nicks or recess can harbour just about anything and should be cut out.

Avoid eating grapes with open splits.

Thoroughly cook meats and fish. Do not eat raw or uncooked meats or fish.

Check for worms, especially on fish.

Keep all work surfaces clean.

Practice good personal hygiene. Wash your hands before eating and after going to the bathroom, changing diapers, or handling pets. Keep your fingernails short and clean. Parasites can live for two months under the fingernails.

Keep your living environment clean.

Do not walk barefoot on warm, moist soil or while working in the garden. Use gloves and shoes for protection.

When swimming in rivers, lakes, ponds, or public swimming pools, avoid swallowing or drinking the water. Avoid swimming if cuts or open sores are present.

If pets are infested with parasites, de-worm and keep them outside. You are at higher risk in contracting worms when pets are allowed indoors. Dogs and cats are host to many parasites that humans can contract

Overuse of antibiotics. Reducing the numbers of friendly bacteria in the colon allows for the proliferation of parasites.

Use more cloves with every meal. Adding some cloves to foods will help kill the eggs from parasites in the intestinal tract.

So, if you or your family have been abroad recently, or keep pets, or have unexplained IBS symptoms do not forget that it may well indeed be a parasite!

Listed below are some of the parasites I see in test results on a daily basis, although there are hundreds more:

Blastocystis hominis. B. hominis has recently been reclassified as a protozoa. This organism is transmitted via the fecal-oral route or from contaminated food or water. Prevention can be enhanced by improving personal hygiene and sanitary conditions. Symptoms can include: diarrhoea, cramps, nausea, fever, vomiting and abdominal pain. B. hominis has been associated with irritable bowel syndrome, infective arthritis and intestinal obstruction.

Cryptosporidium spp. Infection is thought to occur by direct person-to-person contact. Contamination of public water supply has been associated with outbreaks. Raw foods such as unpasturized milk and raw meat can also harbor the organism. Acute infections can mimic Crohn’s disease with villus atrophy (similar to the damage seen in coeliac disease). Clinical symptoms include nausea, low-grade fever, abdominal cramps, anorexia and up to 5-10 watery bowel movements a day, which may be followed by constipation. You can also be asymptomatic.

Dientamoeba fragilis D. fragilis is common in pediatric populations and patients under the age of 20. D. fragilis is known to cause non-invasive diarrhoeal illness in humans. 90% of children are symptomatic, whereas only 15-20% of adults are. The most common symptoms associated with D. fragilis are intermittent diarrhea, fatigue, abdominal pain, fatigue, nausea, anorexia, malaise and unexplained eosinophilia. Diarrhea is predominately seen during the first 1-2 weeks of infection and abdominal pain may persist for 1-2 months.

Entamoeba histolytica E. histolytica belongs to the ameba family of protozoa. This organism has been recovered worldwide, though is more prevalent in the tropics and subtropics. Some patients may experience symptoms that mimic ulcerative colitis. Others still may have a gradual onset of symptoms including diarrhea, colicky abdominal pain. The incubation time for those symptomatic can vary from 1-4 weeks. With the onset of dysentery, diarrhea can occur with up to 10 movements a day.E. histolytica should be treated even if patients are asymptomatic.

Giardia lamblia is the most commonly diagnosed flagellate in the intestinal tract. Giardia intestinalis and Giardia duodenalis are also used as names for this organism. Infection occurs via faecal oral transmission or from food and water contaminated with the cysts. Giardia lamblia has a worldwide distribution, though is more common in warmer climates than cooler ones. Isolation of the organism is more prevalent in children or those living in close quarters with poor sanitary conditions. For those symptomatic, there can be an acute and a chronic phase of infection. After an incubation period of 2-20 days, symptoms of watery diarrhea, nausea, low grade fever and chills can occur lasting only a few days. Acute infection can mimic food poisoning, bacillary dysentery, viral enteritis, acute intestinal amebiasis or travelers diarrhea. In the chronic phase, symptoms can include recurrent foul smelling diarrhea, abdominal distention, belching and heartburn.