Parasites have no socio-economic boundaries. The word parasite can cause us to conjure in our minds all kinds of creatures, from small “creepy crawlers to tapeworms many feet long. In fact, parasites range in size from those that are microscopic to ones exceeding 30 feet in length. Parasitic infections are often believed to be restricted to people who live in underdeveloped areas of the world where poor sanitary conditions and insect-control problems exist, or to wilderness backpackers who drink contaminated water. Intestinal parasitic infections, however, have a global distribution with no socio-economic boundaries.
Experts believe that parasitic infections have reached epidemic proportions in this country. It is estimated that today nearly 50 million Americans harbor intestinal parasites, with the number growing rapidly. Several phenomena are responsible for this rising number. Increase in tourist travel to foreign countries where parasites are endemic is contributing to the situation, as is the influx of people to the United States from countries with high rates of parasitic infection. In addition, pollution, especially of our water supplies, has added to the epidemic. Another contributing factor is that many people infected with parasites remain asymptomatic until their immune systems are sufficiently weakened by stress or another disease, allowing them to pass the infection on to many other individuals before they seek treatment.
Giardia Lamblia – A Common Parasite in the United States
One parasite in particular that has become exceedingly widespread in this country is Giardia Lamblia, a flagellated protozoa (single-celled organism with a whip-like tail). According to an article in the American Journal of Epidemiology (Vol. III, pp. 1-12 , 1980). Giardia is believed to be the most common cause of parasitic disease in the United States. It is also considered the leading culprit of waterborne disease in this country. Estimates of infection rates of North Americans having Giardia range from 1.5 to 22 percent (Parasite/ Pathogen Primer, Great Smokies Diagnostic Laboratory, 1990). According to Audubon (Vol. 83, No.3, pp. 95-97, 1981), 16 million Americans are probably infected with Giardia.
Giardia Takes Two Forms
Giardia organisms take two forms. In one form, referred to as “trophozoite,” the parasite, using what is commonly referred to as a “sucker cup,” attaches itself firmly to the lining of the small intestine where it multiplies rapidly within days. If symptoms occur, they usually present themselves approximately ten days after infection. In the fecal stream, the parasite takes on a second form. It envelops itself in a cyst and is excreted in the feces. The cyst is microscopic, only 10 – 20 microns in size. Approximately 16,500 cysts can sit on the head of a pin. Stool from someone who is moderately infected with Giardia may contain close to 300 million cysts. It takes the ingestion of only 10-25 of these tiny cysts for a person to contract giardiasis, the disease caused by infection with Giardia.
An individual infected with Giardia may be a symptom-free carrier of the disease and excrete the infectious cysts for months (American Journal of Tropical Medical Hygiene, Vol. 24, pp. 237-242, 1975). These cysts are quite hardy. Although they are destroyed rapidly by drying, they are believed to be capable of surviving for long periods of time in wet conditions, even up to two months in close to freezing water (Experimental Parasitology, Vol. 47, pp. 284-291, 1979).
Transmission of Giardia is most frequently spread by the fecal-oral route. It is easily transferred to humans through contaminated drinking water, which has become a common vehicle for this protozoal infection. Water supplies become contaminated by sewage and animal feces.
Animals, in particular beavers, can frequently infect human water supplies. Once beavers become infected with cysts of Giardia, they continually re-infect the ponds in which they live and pass the cysts downstream. As they migrate to new territories, the beavers infect more water areas. According to wildlife biologist Charles Hibler of Colorado State University, most animals infected with Giardia do not completely rid themselves of the parasite. Instead, they go on shedding the infectious cysts even though the symptomatic phase of the illness might have passed. Hence, Giardia continues to thrive and becomes endemic to those areas which have already been contaminated with the parasite.
Of the lakes, rivers and creeks tested in North America, it was found that 10-28% harbored Giardia. This parasite has also been found present in 3.4% of United States drinking water samples from water supplies that receive conventional treatment (Parasite / Pathogen Primer, Great Smokies Diagnostic Laboratory, 1990). Cysts of Giardia tend to be extremely resilient and are often not filtered out by conventional water treatment plants, especially by those which are older and less effective. Moreover, the parasite, in its cyst form, is resistant to ordinary chlorination techniques. Between 1965 and 1981, there were 53 reported waterborne outbreaks of giardiasis affecting 20.039 individuals in the United States. Drinking water served as the vehicle of transmission in these outbreaks of giardiasis (Giardia and Giardiasis, Eds., S.K.Erlandsen and E.A. Meyer, Plenum Press, New York, p. 247, 1984).
An article in the Journal of the American Medical Association, (Vol. 259, No. 12, p. 1810, 1988) finds “90 percent of infections (with Giardia) are acquired by drinking unfiltered surface water (usually municipal drinking water from streams or rivers) or from diaper-aged children who attend day-care centers.” The authors note also that chlorinated municipal drinking water that meets standards in regard to coliform bacteria can still harbor Giardia if the water treatment process does not include an adequate filtration system. It is estimated by these authors that close to 40 million Americans today are living in communities, primarily in mountainous regions, that are being supplied by unfiltered surface water. Add the fact that these areas are visited by a vast number of vacationers during the summer and winter months, and the number of potentially infected people becomes staggering. It is important to note also that well water can become contaminated with Giardia and serve as another route of transmission of the infection.
According to Gunther Craun of the U.S. Environmental Protection Agency, “Since surface water supplies are subject to fecal contamination from a variety of animal and human sources, water supplies must provide adequate treatment that is capable of removing and inactivating Giardia cysts. In all but exceptional situations, effective filtration must be provided to prevent the waterborne transmission of giardiasis. Giardia cysts can be inactivated by chlorine, but high concentrations of chlorine and long contact times are required.” (Giardiasis, Ed., E.A. Meyer, Elsevier Science Publishers, New York, p. 290, 1990).
Day-care centers, as mentioned previously, are also common sources of Giardia infections. According to the Merck Manual (Merck Sharp and Dohme Research Labs, New Jersey, P. 238, 1982) rates of Giardia greater than 50 percent have been reported in centers that provide care for very young children. A significant rate of infection among day-care center staff and among household members of infected children has also been cited.
Another means of infection with Giardia is the ingestion of raw food that has been handled by a person with contaminated fingers resulting from poor bathroom hygiene. Salad bars, under-cooked chicken, meat and fish (take note connoisseurs of steak tartare and sushi) can be breeding grounds for Giardia and other parasites. Even our household pets can transmit the Giardia infection. Therefore, very few of us are free from the risk of exposure to this parasite. Because Giardia can also be spread through sexual contact involving fecal exposure, the infection is believed to be quite prevalent in the homosexual population. Leo Galland, a leading expert in the field of parasitology, has stated that the development of AIDS may be enhanced by protozoal infections.
Symptoms of Giardiasis
A variety of symptoms may alert one to the onset of this disease. Acute giardiasis is characterized by explosive diarrhea which is foul smelling and watery (with no blood or mucus), weakness, nausea, loss of appetite, flatulence, abdominal distention, and cramps. In many cases, the disease is self-limiting, with recovery within six weeks. In some individuals, however, the disease persists and develops into a chronic syndrome which, according to many authorities on the subject of giardiasis, may encompass a wide range of symptoms. These include recurring diarrhea, abdominal pain, bloating, flatulence, nausea, vomiting, loss of appetite, weight loss, chronic constipation, ulcerative colitis, irritable bowel disorder, malabsorption problems, allergic hypersensitivity, bronchial asthma, urticaria, arthritis, debility, fatigue, and immune suppression. It is even said to be a cause in some cases of the childhood syndrome referred to as “failure to thrive”, in which a child’s physical and mental development are impaired. It is important to note that many individuals suffering from a chronic infection with Giardia often experience only mild digestive complaints.
The following is from an article coauthored by Galland which appeared in the Journal of Nutritional Medicine (Vol. 1, pp. 27-31, 1990): “We applied a sensitive diagnostic test for Giardia Lamblia infection to 218 patients with a chief complaint of chronic fatigue. Sixty-one patients were infected with Giardia. All had minor gastrointestinal symptoms: bloating (61 % ), flatulence (62%), loose bowel movements (56%) and constipation (50%). All patients also complained of other systemic symptoms: depression (61 %), myalgia (34%), headache (41 %), muscle weakness (46%) and flu-like feelings (34%).The median duration of the illness was two to three years. Treatment of giardiasis produced a complete cure of fatigue in 13/48 patients, marked improvement in 21/48 patients, some benefit in 8/48 patients and no benefit in 6/48 patients. Viral symptoms such as fever, myalgia and sore throat were much more common in fatigued patients with giardiasis than in fatigued patients without giardiasis. Giardia infection may be an important cause of chronic fatigue and myalgic encephalomyelitis (ME) in patients with minor digestive disturbances.”Galland encourages anyone with immune disorders, including multiple allergies, unexplained fatigue, or chronic bowel problems, to be tested for intestinal parasites.
Giardiasis can severely impact nutritional well-being. In chronic giardiasis, specific nutrient deficiencies have been reported because. according to some sources, the parasite adheres to the walls of the small intestine and covers its absorbtive surface, interfering with the absorption of vital nutrients. Nutrient deficiencies found in individuals with chronic giardiasis include low levels of carotene, vitamin A, folic acid , and vitamin B 12.
Susceptibility to Giardiasis
What lowers a person’s resistance to parasitic infections: Susceptibility to parasitic infections is increased by several factors. Constipation encourages the overgrowth of pathogenic organisms. A diet lacking fiber lengthens the time required for food to pass through the digestive tract and increases the putrification time of food in the intestines. This creates an environment in which parasites thrive. Hence, a low-fiber diet, abundant in sugar and refined carbohydrates, has been found to be a predisposing factor to Giardia infection.
Other conditions which increase the chances of an individual to develop giardiasis include gastrectomy (surgical removal of the stomach) and achlorhydria (the absence of hydrochloric acid). In a study cited in the Annals of Internal Medicine (Vol. 78, No. 2, pp. 271-276, 1973) it was reported that ” …. Perhaps gastrectomy renders a patient more prone to Giardia infestation, for it is conceivable that normal gastric function ordinarily provides a significant barrier to infection by Giardia.” The authors of the article state that although Giardia is a parasite which resides in the duodenum (a part of the small intestine), some achlorhydric patients have been reported to harbor the parasite in the gastric content.
In addition, it was found that simply having the condition of hypochlorhydria (reduced gastric acid secretion) could also lead to Giardia infection. The authors concluded by noting that patients with giardiasis ” … frequently have hypochlorhydria or achlorhydria and gastric trophozoites accompanying diarrhea, weight loss and malabsorption.”
Additional factors that hamper the resistance of an individual to invasion by parasites include an impaired immune system with immunoglobulin deficiency, pancreatic enzyme deficiency, antibiotic therapy which disturbs the balance of the bacterial flora in the digestive tract and promotes the growth of “unfriendly” bacteria, nutritional deficiencies, stress and fatigue. Interestingly, an article in Nutrition Reviews (Vol. 45, No. 8, pp. 236-238, 1987) reported that giardiasis seems to occur less frequently in breast-fed infants than in those who are not breast-fed. This effect has been attributed to an enzyme present in human milk referred to as bile salt-stimulated lipase.
Detection of Giardia
Giardia infection is often quite difficult to detect. Single stool sample examinations, along with standard laboratory methods of detection, frequently yield false-negative results. In the .Journal of Clinical Microbiology (Vol.27, No. 9. pp. 1997-2002. 1989), it was stated, “Clinicians agree that the diagnostic success rate of stool examination in most clinical laboratories is roughly 50 to 70 percent. To further complicate matters, many patients with Giardia infection excrete infectious cysts in stool intermittently, necessitating collection and examination of several stools from a patient over several days to weeks”.
To make detection even more difficult, it has been found that the Giardia cysts seem to make their home in the mucus membranes of the colon, near the rectum, hence there are times when they may not even be found in the stool sample. To overcome this limitation in the detection of Giardia cysts, a technique was developed by using a sample of rectal mucus obtained by anoscopy, referred to as the rectal-swab technique of specimen collection.
At present, many holistic physicians are utilizing either this rectal-swab technique of sample collection or a method of obtaining three stool samples collected over several days, including a “purged” stool sample. The samples are sent to laboratories that employ advanced methods of parasite detection, including special stains and enhanced microscopic techniques. Two such laboratories are Genova Diagnostics in Ashville, North Carolina, of which Galland is the Senior Research Consultant, and Meridian Valley Clinical Laboratory in Kent, Washington.
It is not uncommon for patients with candidiasis (an overgrowth of yeast cells) to harbor a variety of intestinal parasites. According to Towbridge and Walker, authors of The Yeast Syndrome (Bantam Books, New York, pp. 374-375, 1986), protozoal infections can contribute to the “Candida Syndrome.” They quote Warren M. Levin, M.D.: “With the cooperation of a specialist in parasitology, Louis Parrish, M.D. of New York City, I have been finding an extraordinary incidence of Entameba histolytica [the cause of amebic dysentery] and Giardia Lamblia in the careful rectal swabbing of candidiasis patients … these protozoa organisms encourage the growth of Candida albicans and vice versa.
Treatment of Parasitic Infections
The conventional “treatment of choice” for giardiasis recommended by the Centers for Disease Control is the drug Atabrine (quinacrine). Flagyl (Metronidazole) is also frequently used, although it is not approved by the Food and Drug Administration for this purpose. Furoxone (Furazolidone) is another drug used for the treatment of Giardia infections, especially in children, as it can be dispensed in a liquid solution. All of these drugs can have toxic side effects which include nausea, vomiting, abdominal pain, rashes, and headaches. Atabrine has also been known to cause a toxic psychosis, and Flagyl can cause a severe overgrowth of Candida albicans.
The hoilistic community has been using natural substances which have proven to have significant antiprotozoal activity. These include the Chinese herb Artemisia annua. This herb is believed to have been used in China for the treatment of malaria for 2,000 years. Other anti-protozoal herbs include Portulacca, Mume fruit, Clove bud, Quassia fruit, and Quisqualis fruit. All of these herbs along with Artemisia annui are included in my Anti-Parasite II formula.
Another product for the treatment of giardiasis is citrus (grapefruit) seed extract. This extract is contraindicated for those with sensitive stomaches.
As you can see, there are a number of natural products available to those with protozoal infections. Your health care provider can advise you on which are appropriate for your condition and on any contraindications to their use, such as pregnancy. It is also important to mention that it is essential to examine and treat (if appropriate) family members of an individual with giardiasis, as the infection is commonly spread throughout families.
Giardia infections are widespread in this country. Be aware of the routes of transmission and take the appropriate precautions to avoid infection.
Laura Mann is a Doctor of Oriental Medicine, specializing in acupuncture, herbal medicine, and homeopathy. Her main areas of treatment include pain and stress management, women’s care, and immunological diseases. Dr. Mann is currently practicing in Agoura Hills, CA. Phone 818-575-9488.
Here are some helpful tips to protect yourself from parasitic infections:
* Be sure that all meat, chicken, and fish dishes are completely cooked, meaning “well-done.”
* Do not use a microwave oven to cook meat, chicken, or fish, because the heating action of microwaves often does not thoroughly cook these foods.
* When dining out, avoid salad bars and any dishes that are not completely cooked.
* In your home, install a high quality water filter system that is reported to successfully filter out parasites and cysts.
* Carry a small bottle of your own filtered water to avoid drinking tap water.
* Remember, bottled water in most cases has not been filtered, hence those tiny Giardia cysts can be lurking there too.
* Since our rivers and lakes maybe contaminated with Giardia, avoid swallowing water when swimming or skiing in them.
* When camping, avoid drinking water from local springs. Either bring your own filtered water or boil or microfilter any non-bottled drinking water. There are several microfilters on the market specifically designed for this purpose.
* Pets should be de-wormed periodically, and don’t forget to wear gloves when changing the cat litter box.
* Always wash your hands, kitchen counters, and utensils with soap and hot water after handling raw meat, chicken or fish.
* Remember to wash your hands after changing your child’s diaper, after using the toilet, and before eating.
* Avoid sexual practices which risk fecal-oral contamination.