Treating Lyme Disease can be complicated by co-infections with organisms such as Ehrlichia, Bartonella, Babesia, various Mycoplasma and Tularimia as a result of having been bitten by a tick or other insect that transmitted these bacteria and/or parasites along with the spirochete Borrelia. As if that weren’t enough to deal with, there is something else you need to consider in your differential diagnosis. Besides the aforementioned co-infections, you could also be harboring intestinal parasites which were not transmitted by a tick, but, rather, were acquired by ingesting contaminated food or water or through poor hygiene practices.
We will now discuss why intestinal parasites could be causing a stalemate in your Lyme disease treatment – I will focus on the most commonly acquired parasite being the protozoa Giardia lamblia which causes a disease called Giardiasis – and then we will cover some tips for diagnosing and treating a proven or suspected case of Giardiasis – something I have had first-hand knowledge with!
You Mean I Can Get Parasites Anywhere?
At some point in your life, you or someone you know may have been stricken down with what is often jokingly referred to as “Montezuma’s Revenge” – aka, traveler’s diarrhea. Many people refuse to travel to Mexico for fear that they too will succumb to this ailment during or after their visit south of the border. Yet, what most people are not aware of is that one can become infected with intestinal parasites literally anywhere; Third World countries do not hold special claim over this problem in the least.
If you eat out in restaurants, or even at someone else’s home, where you do not have control over the preparation or handling of your food and utensils, if you drink tap water (even some bottled water), swim in lakes or streams, don’t wash or cook your food properly, or let your pets sleep on your bed, your chances of getting a parasitic infection greatly increases. The way you become infected is to unknowingly ingest fecal matter (that of a human or animal) that has the parasites in it – gross, yes, but true. Think about it, if you are eating in a restaurant or at a buffet, you have no control over who or what is touching your silverware and food – and please, forget about ever requesting ice cubes with your drink!
Giardiasis As The Most Common And Most Commonly Overlooked Parasitic Infection
Giardiasis, an infection of the small intestine (sometimes the gall bladder too) by the single-celled parasite Giardia lamblia, is at epidemic proportions throughout the world. Like the Lyme disease causing agent Borrelia, Giardia is able to go into a protective cyst when under threat by their surrounding environment. Also like Borrelia, Giardia are adept at evading their host’s immune system as they frequently change their genetic makeup to avoid detection by the body; they are able to switch the antigens on their outer surface protein (OSP) coats so that when one antigen is recognized by the host’s immune system, all they do is change their OSP “cloak”, and thus go undetected.
“Giardia infection can occur through ingestion of dormant cysts in contaminated water, food, or by the faecal-oral route (through poor hygiene practices). The Giardia cyst can survive for weeks to months in cold water, and therefore can be present in contaminated wells and water systems, especially stagnant water sources such as naturally occurring ponds, storm water storage systems, and even clean-looking mountain streams. They may also occur in city reservoirs and persist after water treatment, as the Giardia cysts are resistant to conventional water treatment methods such as chlorination and ozonolysis. Zoonotic transmission is also possible, and therefore Giardia infection is a concern for people camping in the wilderness or swimming in contaminated streams or lakes, especially the artificial lakes formed by beaver dams (hence the popular name for giardiasis, “Beaver Fever”).
“In addition to waterborne sources, fecal-oral transmission can also occur, for example in day care centers, where children may have poor hygiene practices. Those who work with children are also at risk of being infected, as are family members of infected individuals. Not all Giardia infections are symptomatic, and many people can unknowingly serve as carriers of the parasite.
“The life cycle begins with a noninfective cyst being excreted with the feces of an infected individual. The cyst is hardy, providing protection from various degrees of heat and cold, desiccation, and infection from other organisms. A distinguishing characteristic of the cyst is four nuclei and a retracted cytoplasm. Once ingested by a host, the trophozoite emerges to an active state of feeding and motility. After the feeding stage, the trophozoite undergoes asexual replication through longitudinal binary fission. The resulting trophozoites and cysts then pass through the digestive system in the faeces. While the trophozoites may be found in the faeces, only the cysts are capable of surviving outside of the host.” 1
Note: To be vigilant, you should always cook your food thoroughly and always boil your water to kill any possible cysts of Giardia hanging out there – even bottled water. In order to kill the cysts you must BOIL the water for at least 3 minutes.
For many people who unwittingly ingest the cysts of Giardia, fortunately, their immune system will fight off the parasites before they can multiply and take up residence in the small intestine (sometimes they infect the gall bladder as well). Others will develop Giardiasis, and although the parasites set up shop in their gut, they do not develop symptoms immediately or ever for different reasons. Common symptoms of Giardiasis are allergies, malabsorption, lactose intolerance, inability to digest fat, gluten intolerance, diarrhea, constipation, headaches, arthralgia, asthma and psychiatric disturbance. With such a wide range of possible symptoms, you can see why Giardiasis is so commonly overlooked as being the culprit. More bad news, having parasites in the gut often sets one up for SIBO (small intestine bacterial overgrowth) as well as an overgrowth of the normal intestinal yeast, both of which will often persist until the infection with Giardia is cleared.
As with Lyme disease, most of the tests for intestinal parasites are horribly inaccurate
The most common test performed for intestinal parasites is the ova and parasite stool test (O & P stool test) which very frequently fails to detect parasites in stool samples – some test. Firstly, parasites such as Giardia lamblia may only shed their cysts a few days a month if that, and so the likelihood of any cysts showing up in a stool sample to be tested is low. The likelihood of any cysts that do end up in the stool sample being picked up by a lab technician? Regrettably low. It is very difficult to detect parasites in stool samples, especially Giardia lamblia, even if they are there, and even the most highly trained parasitologists with years of experience in looking at stool samples often miss them. Given that, I would not have much confidence in a regular lab technician detecting parasites from a sample.
In my quest for answers to what had contributed to my sudden illness, I had seen a wonderful doctor who felt that one of the contributing factors was that I had Giardiasis – an infection of the small intestine, less commonly the gall bladder, with the protozoan parasite Giardia lamblia. The doctor relayed to me his decades-long experience with having patients he strongly suspected had Giardiasis tested and retested for parasites at different labs across the country and how horribly inaccurate he felt the tests were, even at some of the “top laboratories”. When he would send people that he suspected had Giardiasis for the standard O&P stool test, they would, without exception, come back with negative tests results over and over. Yet, when he would do a therapeutic trial – treating them with a medication that was mostly specific to Giardia lambia (I will discuss treatment shortly) to test his diagnostic hunch – they would get better. The patients were indeed infected with Giardia lamblia even though the lab results were saying otherwise. Sound familiar?
I also learned that a better test for parasites than the O & P stool test is a rectal mucosa test where a sample of mucous from your anus is taken and then looked at under a microscope for possible parasites. The rectal mucosa test is far from ideal and not in any way foolproof, but it superior to the O&P stool test. However, most parasitologists do not perform this type of test even though it is more likely than other means to proffer a parasite-laden mucous sample (I was very lucky to find a doctor in Manhattan who does perform this type of rectal smear – Dr. Kevin Cahill, a very well-respected parasitologist. He found Giardia lamblia in the mucous sample he took from me the first time!)
The Best Way To Treat Suspected Or Proven Giardiasis
Giardiasis is often treated with a ten-day to two-week course of the antibiotic Flagyl, generic name, metronidazole (you want to use brand name antibiotics for the most part as generics can have excipients that are not in the brand name and they also do not always work as well as the brand name drugs – my LLMD told me he had to stop using the generic of Biaxin as it just did not work as well as the brand name). Flagyl has a very high failure rate for Giardiasis which presents a problem. The reasons for failure are varied: lack of efficacy of the drug itself, being immunocomprimized, having a lack of IgA (which can be tested for by a blood test), the virulence of the particular strain(s) of Giardia in the person’s gut as well as each person’s unique immune system. The drug Tinidazole is sometimes for Giardiasis as is Alinia and both have the same problem with high failure rates in clearing the infection.
Quinacrine May Be Part Of Your Cure
However, fortunately, there is an antiprotozoal that has a very high efficacy in killing Giardia which is called quinacrine (brand name Atabrine). Quinacrine CANNOT BE TAKEN UNLESS you have a G6PD blood test performed (most any lab can do this) as some people are born with what is called a Glucose-6-phosphate dehydrogenase deficiency and if you have the deficiency and take quinacrine, you can have a potentially fatal acute haemolysis – again, you are either born with this deficiency or not, and so the blood test will tell you if you have it or not. For Giardiasis, you take quinacrine capsules at 100mg PO three times daily for 21 days (quinacrine is derived from the bark of a Cinchona Tree and has a yellow tone.)
**Quinacrine can cause a temporary yellowing of the skin which should only last a few months. On rare occasions it can cause a psychotic episode and so the best way to handle this is to titrate the quinacrine – build up to the full dose slowly. To do this you will need to buy Now Foods Veg-Capsules Double “00” Empty Capsules, 250-Count
“>NOW Foods brand 00 Vcaps which are non-gelatin veggie capsules. Over the first few days you will pour a tiny amount of quinacrine from the capsule it came in, into a 00 veggie capsule and then you will keep building up the dose until you are tolerating a full capsule. Once you are there, then you can begin taking the quinacrine at the dose of 100mg PO three times daily. For this reason, if you decide to titrate the dose, you will need your doctor to prescribe a few days extra of the quinacrine.
You will need a doctor to call in a script to a compounding pharmacy to make up the quinacrine capsules for you. Expert Compounding Pharmacy and Nekos-Dedrick’s Pharmacy are two such compounding pharmacies.
Now, although not as well documented, there have been reports of failure with quinacrine as well, and so the recommendation for such cases of refractory Giardiasis is to treat it with a combination of quinacrine and Flagyl for 21 days: quinacrine 100mg PO three times daily + Flagyl (metronidazole) 500mg PO twice-daily.
What You Can Do At Home If You Suspect Giardiasis
The symptoms for Giardiasis and Lyme disease can overlap and so you must take that into consideration – but prolonged diarrahea or constipation may be a clue to your having Giardiasis. So, here is a simple test you can do at home to see if perhaps you are harboring Giardia lamblia in your gut (I learned this from the very smart and very kind doctor I mentioned that had correctly diagnosed me as having Giardiasis among other things – the big one being Lyme disease).
Grapefruit-seed Extract Therapy
To begin this protocol you will need:
Grapefruit-seed Extract (GSE) in the liquid concentrate form (Nutribiotic brand only).
Although GSE may or may not be helpful in dealing with an infection with Borrelia, if after taking the GSE over a period of time stops the diarrhea and/or constipation, and you notice a dramatic improvement in your symptoms, then that is a big clue that you may indeed have Giardiasis as well as or instead of Lyme disease. As with when one is taking antibiotics for Lyme disease, you may experience a temporary worsening of your symptoms during the first week or so (Jarisch-Herxheimer reaction) of using the GSE as you are exposed to more of Giardia’s toxic substances. GSE is not effective alone as a cure for Giardiasis, but it has the ability to interfere with Giardia’s ability to replicate and swim about. The temporary worsening of your symptoms is nothing to be alarmed at, and is actually a good sign as it adds weight to Giardia being a cause, or partial cause, or your symptoms.
What you will do on the protocol is titrate yourself by slowly increasing the amount of GSE you take each day which will prevent a large herxheimer from occuring.
A. Add one drop of the liquid into 4 ounces of water (use a wide glass so you are better able to stir the liquid).
B. Vigorously stir the liquid for approximately 2 minutes to make sure it is properly mixed with the water.
C. Take a small sip (1.4 mouthful) and chase it with 1/2 glass of plain water. Put the rest of the glass with the GSE mixture in the refridgerator and in an hour, if there is no problem, repeat the same procedure, this time taking a full mouthful. Do this every hour until the entire 4 ounces has been consumed. It has a bitter taste. If you like and tolerate juice, you can use whichever one you want in place of water to dissolve the extract.
All future doses of the GSE liquid in 4 ounces of water or juice should be taken on an empty stomach to make sure that you get the maximum contact with the lining of your gastrointestinal tract.
A. Put 1 drop into 4 oz. of water and mix well (see above). Drink this mixture in the morning. Take it all at once – you no longer have to build up the dose as you did on the first day. You may eat 1/2- to 1 hour after taking the liquid.
B. Repeat this procedure in the evening.
Each day thereafter increase the dose by 1 drop in the morning and 1 drop in the evening:
2 drops in the morning
2 drops in the evening
3 drops in the morning
3 drops in the evening
3 drops in the morning
3 drops in the afternoon
3 drops in the evening
Stay at this dose for the one to three weeks and make note of any improvements in your symptoms. Some people stay on GSE for extended periods of time, but it is better to treat the suspected or proven infections with Giardia lamblia as the GSE will not effect a cure, although it may provide symptomatic relief. If you want to then speak with a doctor about treating for suspected Giardiasis, re-read the beginning of this article on testing. You also may want to ask your doctor for a therapeutic trial of an antiprotozoal (again, re-read the above information).
** A research and development company, Phthisis Diagnostics, is coming out with a highly sensitive PCR test kit (look for it to be used in certain labs in 2011) to fill the void for a sensitive and accurate test for picking up Giardia lamblia and other parasites in a stool sample. The PCR test works by detecting the DNA of Giardia.