Deworming - who should? Is it worth it? How should it be done?

The prevailing narrative in Poland and Europe is that parasites in humans are a problem of the past. It is believed that nowadays deworming is only necessary in animals, while in humans parasites are limited to pinworms in pre-school children or lice. But is this really true?

Ask a doctor friend how many hours at university were devoted to parasite education. Most will answer that the subject was covered in just a few hours. This means that a person with a basic knowledge of biology who spends a month studying the subject may know more than many doctors. This is not how it should be.

Interestingly, valuable knowledge about parasites can be gleaned from... veterinarians. They are the ones who learn much more about parasites in their studies than medical doctors.

What was it like in the past?

My grandmother told me a story from when the whole family lived in the countryside. Her sister, in her twenties, had been trying to get pregnant for a long time without success. After three miscarriages, she decided to go to the hospital and have tests done. These were tests for antibodies in the blood - not very precise at the time, but the result was surprising. The presence of feline roundworm, canine roundworm, human roundworm, flukes, Giardia lamblia and several other parasites associated with ducks and geese were identified.

After taking deworming medication, her sister became pregnant and gave birth to a healthy baby a few months later.

Although today we live in much better conditions than our ancestors, parasites have not disappeared. Many people own dogs and cats, which can carry cat roundworm, dog roundworm or lamblia. In the summer, we like to swim in lakes, where contact with infected snails can lead to a fluke infection.

Looked at logically, parasites are still present in our environment. The difference is that the problem has been trivialised, instead of being effectively monitored and discussed.

What are the most common symptoms of parasites?

The symptoms of parasites can vary greatly and depend on the type of parasite. Here are some of the most common signals that may indicate a problem:

• Low iron levelswhich does not improve despite a well-balanced diet.
• Weakening and chronic lack of energy.
• Acne on the back and other skin problems.
• Disgruntlement and concentration problems.
• Stomach problems, such as abdominal pain, diarrhoea or constipation.
• Elevated eosinophils in the blood (often associated with allergic reactions) or their chronically reduced levels.
• Nighttime gnashing of teeth (bruxism) and feelings of anxiety.
• Skin lesionssuch as allergies, eczema or rashes.

It is worth remembering that these symptoms are not specific only to parasites, so their presence should be confirmed by appropriate tests. Early diagnosis and appropriate treatment can prevent more serious health problems.

How should parasites be diagnosed?

The first step in diagnosing parasites is to analyse the symptoms. If one experiences the symptoms described earlier, despite a healthy lifestyle, the presence of parasites can be suspected.

Basic research

1. Faecal examination - Mostly recommended. Stool samples are collected three times every two days and then sent to a specialised laboratory. An example of such a place is Olimpiamed in Lodz. Results are usually available after about two weeks. This test can detect, among others, human roundworm or lamblia, but may be insufficient for the diagnosis of other parasites, such as flukes.
2. Blood antibody test - It is used, among other things, for the diagnosis of fluke. Unfortunately, this method is not very precise and does not always give conclusive results.

My experience

From my observations, this research should be taken as a guide:

• Positive result - It is highly likely to indicate the presence of parasites.
• Negative result - Does not rule out infection. Parasites may be present even though they are not detected on examination.

An example is a person with acute anaemia who decided to take anti-parasitic medication despite negative parasite tests. After just three weeks, she saw a significant improvement in her wellbeing and her ferritin levels in blood tests increased threefold.

Holistic approach

Diagnosis should take into account both test results and clinical symptoms. It is worth looking broadly, analysing the whole picture. Sometimes taking treatment experimentally can provide valuable information about potential parasite infection.

My specific case

I decided to get tested for parasites because I had been struggling for 1.5 years with health problems that had no clear cause. Despite getting enough sleep and a well-balanced diet, I felt a constant lack of energy. Every visit to the gym ended in rapid fatigue after just a few minutes of training, and my form was abysmal compared to two years ago.

These physical problems were also joined by depressive states and difficult-to-control acne on my back, which added to my discomfort.

The test results showed the presence of human roundworms. It was a breakthrough in my diagnosis that allowed me to understand the source of my problems and take the appropriate treatment.

Where could I have become infected?

When I analysed my experiences over the last few years, I came to the conclusion that I may have contracted parasites during two particular trips:

1. Bosnia and Herzegovina
   1.5 years ago I was on holiday in Bosnia and Herzegovina. During my stay I swam in a river, and after just three days I got acute poisoning, which lasted as long as three weeks. Today I suspect that it may have been an infection Giardia lambliabecause there were beavers in the river and as many as 95% of their population carry the parasite.
2. Egypt
   About 10 months later, I took a trip to Egypt. This is a country where the statistics for parasitic infections are very high. I suspect that it was there that I became infected with human roundworm.

Parasites not only from exotic travel

Although my cases are related to international travel, not travelling at all guarantees protection from parasites. Several people around me who do not travel have also struggled with similar infections. All it takes is contact with contaminated water, food or animals to put yourself at risk.

What was the treatment like?

Before I started treatment, I spent two months researching the subject. I read a lot of research on PubMed and listened to people with experience in parasite control. I chose a drug with a broad spectrum of action - a nitazoxanide. Here is what my protocol looked like:

Nitazoxanide treatment protocol

1. First cycle:
   • For 3 days I took 500 mg of nitazoxanide twice daily:
     • In the morning: 500 mg nitazoxanide.
     • After 6 hours: probiotic (Dicoflor) to protect the intestinal microbiota.
     • In the evening: another dose of 500 mg nitazoxanide.
   • On the second day, nitazoxanide caused constipation - it was essential to cleanse the body of toxins released by dead parasites. I used 2 tablespoons of magnesium citrate to induce laxation. In addition, the following can be used diatomaceous earth or activated carbon to remove toxins.
   • Supplementation: 10 g of vitamin C per day (divided into 5 doses) to reduce inflammation and support cleansing of the body.

The second day of treatment was the most difficult - the feeling of wellbeing was terrible, which was the result of the release of large amounts of toxins from the dead parasites (so-called die-off effect). The third day was already much better.

1. Pause:
   • After the first cycle I did 14 days breakto allow the body to regenerate. During this time I continued to use the probiotic dicoflor 2 times a day.
2. Second cycle:
   • The protocol was repeated: 3 days of 2 times 500 mg nitazoxanide daily and a probiotic between doses of nitazoxanide.
   • This time my mood was much better, indicating far fewer parasites and toxins in my body.

What results have I been able to achieve?

Already in the first few days of treatment I noticed an improvement in my digestive function and a reduction in depressive states. Here is a detailed description of the results:

• 2 weeks after starting treatment:
  The acne on my back disappeared, which was one of the most noticeable effects.
• One month after starting treatment:
  I felt a significant surge of energy and an improvement in my overall wellbeing. Lab results showed that ferritin levels increased by 30%.
• During treatment:
  Thanks to the use of protective probiotics, vitamin C and magnesium citrate, I experienced virtually no side effects from the treatment.
• After treatment:
  For the next month, I used a multi-strain probiotic to help rebuild the gut microbiota, weakened by nitazoxanide.

Return of symptoms and complementary treatment

A year after deworming, I noticed a slight recurrence of some symptoms, such as intestinal and skin problems. In response, I decided to use fenbendazol for 2 days at a dose of 444 mg per day. Fenbendazol has the advantage of not damaging the intestinal microflora, although it does put a slight strain on the liver.

Results after fenbendazolu

A week after applying it, I noticed that:

• The acne has disappeared.
• The intestines began to work better.

A sensible approach to deworming

Prophylactic deworming in people who feel great makes little sense. Antiparasitic drugs, although effective, can cause side effects, so it is always worth carefully assessing whether the potential benefits outweigh the risks.

Avoiding the unwarranted use of drugs

For example, regular use of nitazoxanide without a clear need, e.g. several times a year, can weaken the intestinal microflora, which will have a negative impact on overall health. Therefore, I believe that antiparasitic drugs should be used judiciously and only when there are clear indications to do so.

When is it worth deworming?

1. Diagnosis based on symptoms:
   If you have symptoms suggestive of parasites (e.g. stomach problems, skin problems, chronic fatigue), it is a good idea to start by analysing them.
2. Faecal tests:
   It is a good idea to carry out a faecal examination, which can confirm the presence of parasites. If the result is positive - deworming is indicated.
3. Negative test results, but poor wellbeing:
   If tests do not show parasites but symptoms are severe, it is worth considering a one-off application of nitazoxanide. If significant improvement is felt after treatment, this indicates that the problem may have been parasite related and it is worth repeating the deworming if symptoms return.
4. No improvement:
   If no difference is felt after treatment, further deworming makes no sense. In that case, we would be putting unnecessary strain on the body and not achieving the benefits.

Deworming only makes sense if there is a rationale for its use. The key is an accurate diagnosis based on symptoms and investigations. The blind use of antiparasitic drugs is ineffective and may do more harm than good. It is important to take an informed approach and always be guided by individual health needs.

For which parasites, which substances?

The choice of the appropriate antiparasitic substance depends on the type of parasite that causes the infection. Here is an overview of the most commonly used drugs:

Available drugs in Poland

1. Pyrantel (Pyrantelum)
   • Availability: Over-the-counter.
   • Action: Only effective against pinworms (Enterobius vermicularis).
   • Limitations: It has no effect on other parasites, making its use very limited.
2. Albendazole (Zentel)
   • Availability: On prescription.
   • Action: Helps in the fight against human roundworm (Ascaris lumbricoides), tapeworms and other parasites.
   • Limitations: Currently, the standard single dose is often not sufficient for effective treatment. It is sometimes less effective than other available agents.

Specialised medicines for specific parasites

1. Praziquantel
   • Application: Treatment of fluke infection (Schistosoma) and tapeworms.
   • Effectiveness: Very high in the fight against these parasites.
2. Metronidazole
   • Application: Treatment of infections caused by Giardia lamblia.
   • Limitations: It has numerous side effects (e.g. nausea, headaches, exhaustion of the intestinal microflora) and the efficacy against lamblia is average.
3. Nitazoxanide
   • Application: Effective against Giardia lamblia, human roundworms, tapeworms and many other parasites.
   • Pros: Broad spectrum of action, minimal side effects, very good safety profile.
   • Availability: Unfortunately, it is not available in Polish pharmacies, but can be purchased without a prescription in countries such as Egypt and Thailand.

Why did I choose nitazoxanide?

I decided on nitazoxanide because of its:

• Broad spectrum of action - acts against both intestinal parasites and certain bacterial and viral infections.
• Security - has minimal side effects compared to other drugs, e.g. metronidazole.
• Effectiveness - can cope with many types of parasites, making it a more versatile solution.

The selection of the right drug should take into account the type of parasite and potential side effects. Nitazoxanide stands out as a safe and versatile solution, although unfortunately it is not available in Poland. Albendazole and praziquantel also have their uses, but often require appropriate dosing and support from a doctor. It is worth approaching the treatment consciously, bearing in mind the specifics of the parasite in question.

Does everyone have parasites?

No, not everyone has parasites, but over the course of a lifetime most people will come into contact with them and may carry them for some time. Parasites are part of the environment and infections can happen even to people with a healthy lifestyle.

When is it worth taking an interest in parasites?

It is worth paying attention to parasites when:

• We experience health problems of unknown origin.
• Our lifestyles are well regulated (healthy diet, physical activity, proper hygiene) and yet they appear:
  • Digestive problems,
  • Skin lesions,
  • Chronic fatigue,
  • Other symptoms difficult to explain.

In such situations, it is worth checking that parasites are not the cause of our problems.

Do we always need to deworm?

No, deworming is not necessary if:

• Our health is in perfect condition.
• There are no symptoms indicative of parasites.

Unnecessary use of antiparasitic drugs can put a strain on the body, so the decision to deworm should be made consciously, based on symptoms and any test results.

Disclaimer

This article is written for educational purposes and is intended to raise awareness of the substance or problem being discussed. It is important to note that a substance or problem is being discussed and not a specific product. The information contained in the text is based on available scientific research, personal experience and is not intended as medical advice or to promote self-medication. The reader should consult any health and treatment decisions with a qualified health professional. After reading the article, the reader will know which doctor to seek.