Dr. Ilana Gurevich speaks about Parasites and Gut Health with Dr. Ben Weitz.
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3:45 Dr. Gurevich said that she finds that in her speciality GI practice 60-70% of patients that she sees with functional GI disorders also have a protozoa or another form of parasite.
4:17 If the testing shows multiple problems with the GI tract, such as SIBO, a parasite, fungal overgrowth, and bacterial overgrowth, it can be a diagnostic conundrum which to focus on first. Dr. Gurevich finds that the patient’s history can help determine if the focus should be on the small bowel or the large bowel. If the patient has had lifelong symptoms, then you should focus on restoring the microbiome in both the small and the large bowel. If the symptoms came on after a recent onset of food poisoning, it might be small bowel IBS. If it came on after international travel, then you should suspect parasites. If there is a lot of bloating and abdominal pain, then you might want to focus on the small bowel. We have effective testing for bacteria in the small bowel (SIBO breath testing), but there is no good way to rule out parasites, protozoa, or yeast in the small bowel without doing a small bowel aspirate, which is not commonly done in clinical practice. Dr. Gurevich said that she will prioritize treating worms first, parasites next, protozoa next and microbiome and biofilms next. It’s interesting what giardia does in the lumen of the intestine, which is that it changes the microbiome. [Here is a paper describing this phenomenon: Barash NR, Maloney JG, Singer SM, Dawson SC. Giardia Alters Commensal Microbial Diversity throughout the Murine Gut. Infect Immun. 2017;85(6):eoo948-16.] If the patient has microbiome issues and giardia, then it makes sense to get rid of the giardia, which then may fix the microbiome problems.
8:09 Some practitioners will also do a second stool test that focuses more on the microbiome, but Dr. Gurevich said that we still don’t know enough about the microbiome to really make too much of a definitive analysis from this. But if she is looking at a microbiome stool test and she sees pseudomonas, she will suspect that there’s a biofilm, which means that there could be parasites, protozoa, and worms that are hiding in the biofilm. If staph and strep are present, that will also make her suspect that there is a biofilm present.
11:52 There are certain parasites that can show up on a stool test like blastocystis hominis and dientamoeba fragilis that may or may not be pathological. [Dr. Hawrelak recently appeared in episode 169 of the Rational Wellness podcast and he feels that these protozoans–blasto and D. fragilis–when found are not usually pathological and do not warrant treatment.] Dr. Gurevich noted that she tried not treating blasto and D. Fragilis after hearing Dr. Hawrelak speak and she was not getting great results, so she went back to treating such patients and this worked better. She often uses the antiparasitic drug, Alinia, usually for 21 days. For the parasite, Giardia, she will use two 10 day courses separated by 10 days. Her treatment protocol will vary depending upon when the full moon and the new moon are. She will do 10 days of Alinia and then the next 10 day cycle she may start 7 days before or 3 days after the next new moon or full moon. She might use herbal antimicrobials in between these treatment cycles. Her favorite antifungal product is Clear Four by Pharmax. Dr. Gurevich notes that she has not had good success us...