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Candida… The Cause of Your Health Problems?

The term Candida refers to a type of yeast. We’ve all heard the term yeast and most of us associate it with the yeast used for cooking and the aroma of fresh baked bread or even a refreshing glass of beer or wine.

Candida organisms pervade our surroundings. They can be found in our air, in our clothing, in warm, moist rooms such as bathrooms, in the books in our libraries, in our carpeting, in foods like bread and cheese and in beverages such as wine, beer and fruit juices. Most importantly, Candida organisms make their homes inside our bodies. They live on our skin and nails, in our mucous membranes and abundantly in our digestive tracts.

There is a large variety of yeasts, but it is the Candida family which tends to create the greatest devastation in humans, particularly Candida Albicans. Candida Albicans is the type of yeast most commonly recovered at sites of infections, and it is the most infectious strain of yeast. It multiplies rapidly and colonizes (makes a home) in our mucus membranes easily.

Most if us were colonized with yeast at birth, as we moved through the birth canal. Under normal circumstances Candida remain benign and are kept under control by the “friendly” bacterial flora in the intestinal tract. These friendly bacteria inhibit the growth of Candida and various harmful bacteria. Some of these beneficial bacteria are Lactobacilli Acidophilus and Bifido Bacterium.

Candidiasis is a term used to describe a condition in which there is an overgrowth of yeast in the intestinal tract. Under certain conditions in the body, the yeast can change from a yeast form to a mycelial form, having root-like growths. While in search of food, these mycelial yeasts can penetrate the walls of the intestines and come into contact with the bloodstream. They then send out toxic waste products from their reproduction. And, due to the damage to the intestinal wall, they allow for the absorption into the bloodstream of other toxins from the bowel, such as undigested proteins, alcohols and ammonia. These toxic products can create serious dysfunction in virtually any system of the body.
Candidiasis can occur in people of all ages and in both sexes. Due to the hormonal involvement with women and the reproductive tract, they tend to present with more symptomology than men, but men are just as likely to develop the condition of Candidiasis as long as the conditions for yeast overgrowth exist.

There are a vast number of symptoms resulting from Candidiasis because of the fact that the fungus and its toxins can exert a negative influence on almost any part of the body. It seems that the first areas of the body to be affected by the yeast overgrowth are the gastrointestinal tract and the uro-genital tract. It is not uncommon for one to experience abdominal pain and bloating, heartburn, colitis, gastritis, flatulence, severe constipation and/or diarrhea, an inability to digest food, chronic bladder and/or vaginal yeast infections, kidney infections and prostatitis.

Candida patients often proclaim, “Everything I eat turns to gas. It takes dynamite for me to have a bowel movement. I’ve been on laxatives for years.” Or, “Every time I have intercourse, I develop a bladder or vaginal yeast infection.”

As the toxic waste products of the yeast and other bowel toxins, undigested proteins, alcohols and ammonias circulate through the bloodstream, one often experiences allergy symptoms. These may manifest as hay fever, sinusitis, chronic ear infections, hives, asthma, coughs, eczema, psoriasis, headaches, dizziness, rapid pulse, anxiety, muscle aches, acne, and food and chemical sensitivities. Hyperactivity in children can also be a result of this phenomenon. The chemically sensitive person may experience symptoms, even around perfumes, colognes, hair spray, pesticides, gas fumes, cigarette smoke, furniture polish, household cleaners, laundry detergents, etc. He or she may also complain of allergies to a long list of foods. And, in time one develops more severe symptoms in response to a wider variety of stimuli. Gradually one becomes imprisoned by his or her allergies.

The central nervous system can soon be affected by the yeast overgrowth. One may experience fatigue, irritability, deterioration of mental faculties, loss of libido, joint pains and stiffness and numbness and tingling of the extremities. Candidiasis can also create or intensify the malfunction of particular glands and organs. It often plays a significant role in thyroid and adrenal disorders, diabetes, hypoglycemia, menstrual irregularities, menstrual cramps, PMS, depression, endometriosis, infertility and miscarriages.

A typical example of Candidiasis is a woman between 20 and 45 years of age. She complains of chronic vaginal itching, burning and discharge. She has numerous vaginal suppositories which she has used to reduce the symptoms, but the symptoms never go away completely and always return. She has chronic urinary infections for which she has been given several broad-spectrum antibiotics, and has been told to take more antibiotics every time she has intercourse. These also are not helping. She is plagued with constant abdominal bloat and gas and has bouts of severe constipation for which she takes a variety of laxatives. At times she also experiences diarrhea for extended intervals. Her menstrual cycle is very irregular, sometimes 35 days, sometimes 50 days. She suffers from extreme PMS, a loss of sexual desire and depression. She says she is having trouble remembering things. Her diet is primarily fast foods. She says she has an incessant craving for sweets, breads and cheese and her favorite food is ice cream.

Patients with this intricate combination of symptoms of Candidiasis often consult a multitude of doctors such as, allergists, neurologists, gastroenterologists, gynecologists, endocrinologists and psychiatrists, and are often told they just need to take it easy for a while. They soon become convinced that they are just being hypochondriacs and that it’s all in their minds.

There are numerous predisposing factors to the development of Candidiasis. It has been demonstrated that Candida organisms can multiply during periods when immunity is low. Conditions which stimulate yeast growth include the use of antibiotics, birth control pills, cortisone and other steroids; pregnancy; diets rich in refined carbohydrates, yeast and mold derivatives; exposure to chemicals; chemotherapy and multiple surgeries. It is not only the antibiotics and other drugs that we purchase at our local pharmacy which act as culprits. It is also the antibiotics and hormones with which our meat and poultry products are inundated. In addition, we are exposed to a vast array of more chemicals through our food, as our produce is often heavily treated with pesticides, dyes and preservatives. Thus, over extended periods of time we ingest low levels of antibiotics, drugs and chemicals.

It has been found also, that Candidiasis often goes hand in hand with chronic viral infections such as Epstein Barr Virus and Cytomegalovirus. This may reflect an immune system so depleted by these viruses that it has no resistance to the yeast overgrowth. And it seems that in some cases, having Candidiasis may predispose one to a chronic viral infection as yeast overgrowth can severely lower ones immunity.

Anyone interested in treating a yeast problem should see a practitioner who specializes in Candidiasis, as its diagnosis and treatment require a significant amount of knowledge and experience. Today there are specific blood tests and stool cultures that can be performed to ascertain if Candidiasis may be affecting ones health. Very important to the diagnosis of this disease is a history of predisposing factors, i.e., use of antibiotics, birth control pills, steroids, etc. The symptoms one is experiencing are also critical to the diagnosis. For example, if a woman says she has extreme food and chemical sensitivities, abdominal pain and bloat and chronic vaginal infections, there is a very good chance Candidiasis plays a part in her illness.

A key factor in the treatment of Candidiasis is strengthening the immune system. Blood work should be taken to ascertain where there are deficiencies. I see Candida patients time after time who are low in the vitamins B12 and folic acid. They are often also zinc deficient. Other vitamins that are used are, for example, vitamins A and C and essential fatty acids such as primrose oil and fish oil. Thyroid and adrenal function should also be tested. Many patients suffering with Candidiasis are also hypoglycemic and/or hypothyroid. In addition, they often are plagued with parasitic infections. These conditions need to be addressed in conjunction with the treatment of Candidiasis.

Dietary changes are essential to the treatment of Candidiasis. Foods such as sugar and other refined carbohydrates, alcohol, dairy products, fermented and smoked foods, foods containing vinegar and foods made from yeast must be reduced and replaced by foods which do not encourage yeast growth, such as vegetables, proteins and complex carbohydrates.

There is a large variety of natural products which kill yeast without creating the side effects associated with western medical approaches. Products containing caprylic acid, undecylenic acid, berberine sulfate and grapefruit seed extract can be very effective for those who can tolerate them. Antifungal herbal preparations containing oregano oil, goldenseal, uva ursi, garlic, pau d’ arco, clove, astragalus, coptis, phellodendron and white oak bark are also effective. Most importantly, the intestinal flora need to be recolonized with the “friendly bacteria,” such as, Lactobacilli Acidophilus and Bifido Bacterium. There are numerous products available now to replace the “friendly” flora that will reach deep into the mucus membranes of the intestines.

As a Doctor of Oriental Medicine and an Acupuncturist I view Candidiasis as primarily a Spleen Deficiency pattern with accompanying dampness, manifesting as a lack of appetite, abdominal gas and bloat, diarrhea or constipation, heavy limbs, heavy sensation in the head (foggy thinking), fatigue, chilliness and cold extremities. There is often a liver component involved, i.e., Liver Heat causing migraines, PMS, insomnia, constipation and irritability and Liver Qi Stagnation creating mood swings, depression, abdominal pain, menstrual cramps, heartburn, etc. Lastly, as with many chronic illnesses, there is a Kidney Deficiency often creating the symptoms of frequent urination, infertility, edema, dizziness, vision problems, ringing in the ears and poor memory.

Acupuncture is extremely beneficial when treating Candidiasis as it can strengthen the spleen and kidneys and disperse the Spleen Dampness and Liver Heat. Acupuncture is also very effective at enhancing the immune system which is crucial when treating a patient with Candidiasis. Combining Acupuncture with dietary guidelines and appropriate antifungal products can be a very successful treatment for eradicating the condition of Candidiasis.

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Giardia Lamblia: The Cause of Your Health Problems?

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.

Parasite Prevention

Here are some helpful tips to protect yourself from parasitic infections:

TIPS

* 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.

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