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Nutritional Nutrition Standard Journal

July, 2024 5

HELMINTHS, PROTOZOANS AND

ECTOPARASITES

Over three hundred different kinds of parasites have the

ability to live in the body.

According to the WHO, these

pathogens are the 17th most neglected tropical disease and

4th leading communicable disease associated with a high

outcome for disability.

The Department of Parasitology says

that over 1.8 billion people are infected with these pathogens.

Given these statistics, education about these microorganisms

is vital and keeping them in mind when assessing patients

should be of the utmost importance.

The three main types of these microorganisms, that infect

humans, are helminths (worms), protozoa, and ectoparasites.

These either act as vectors or directly cause disease.

Helminths are multicellular organisms that take hold of the

digestive tract. They consume vital nutrients from their host

and cause malnutrition as well as micronutrient deﬁciencies.

Protozoa are single-celled organisms that divide and multiply

within its host. Protozoa infections often happen through

contaminated water.

These microorganisms cause many

gastrointestinal symptoms, the most common being bloating,

abdominal pain, diarrhea, constipation, inﬂammation of the

liver, and liver ﬁbrosis.

Disorders associated with these

pathogens are amoebiasis, giardia, blastocystis, and cryp-

tosporidium.

Ectoparasites live on the body or inside the

skin. They are multicellular in nature. These microorganisms

feed off human blood. They cause ocular changes, skin dis-

coloration, severe infection, and death.

These include lice,

scabies, and mites.

These pathogens can be challenging to

diagnose because many migrate at different life stages

through the alimentary tract to other organ systems, including

the liver, gallbladder, spleen, pancreas, brain, heart, lymph,

joint lining, and blood.

The thought that these stealth infections are irrelevant in

the United States breeds the worldwide burden of many over-

looked infections. In 2014, the CDC stated that millions of

Americans are infected with parasitic infections each year.

Tom Frieden, former CDC Director states, “They’re more

common in the US than people realize and yet there is so

much we don’t know about them. We need research to learn

more about these infections to better prevent and treat them.”

The CDC estimates these microorganisms infect over

300,000 Americans and over 300 babies every year. At least

1,000 people are hospitalized per year. Fourteen percent of

our population are exposed to the pathogen that causes blind-

ness. More than 60 million people are chronically infected

with the parasite that causes toxoplasmosis, leading to birth

defects and sometimes death in newborns.

INFLAMMATION

Fifty percent of all deaths seen today stem from inﬂam-

mation.

It is important to understand just how these

microorganisms set off the inﬂammatory process and to con-

sider these infections as a root cause when assessing patients.

These infections, particularly helminths, activate the immune

response

These stealth infections initiate immune T helper

2 cells (TH2) as a means to protect the body against contam-

ination. Once the body is infected, non-hematopoietic,

hematopoietic cells, cytokine, and several more inﬂamma-

tory mediators are released to provide the body with

immunity.

From here, TH2 cells signal protective type 2

immune response that aid in tissue repair or cause an exag-

gerated response from the immune cell. Either response leads

to chronic inﬂammatory diseases and a body that’s

burdened.

This inﬂammation process can be intestinal and

systemic. One study in Mexico tested a sample of pediatric

children and found that at least half of the children had at least

one type of intestinal parasite.

The microorganism isolated

in this group are commonly associated with the body’s nat-

ural systemic inﬂammatory process.

Soil-transmission

helminths (STHs), in particular, have the ability to regulate

inﬂammation by dominating the IL-10 cytokines.

Pathogenic protozoa cause tissue damage, inﬂammation

Parasites

Lori Hudson, DC, RN, DACBN

Helminths, protozoans and ectoparasites are pathogens that infect billions of people every year, including millions

of Americans. They are an underlying factor for many health problems. These pathogens, commonly called parasites

take vital nutrients the body needs, are a source of intestinal discomfort and inflammation, and can even cause death.

Unfortunately, some practitioners fail to recognize the prevalence of these infections and the catastrophic damage

they cause to the body. Becoming more aware of the symptomatology and the body’s response to these pathogens

can aid in the proper diagnosis and thus improve patient outcomes. This article is meant to educate practitioners

about the prevalence of these stealth infections, the inflammatory destruction they can cause in the body, and common

nutritional deficiencies seen with these microorganisms, in order to transform how practitioners evaluate patients

moving forward.

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National Nutrition Standard Journal

6 Vol. 47 No. 3

which can worsen the systemic inﬂammatory process.

Prolonged inﬂammation causes disease. There is a high

correlation between autoimmune diseases and the presence

of stealth infections. Through a process called molecular

mimicry, Cytotoxic T cells and anti-parasitic antibodies

attack the body’s own tissues.

The likeness between para-

sitic and self-antigens allow these microorganisms to go

undetected by the immune system while, at the same time,

induce a state of chronic immunosuppression.

Long term

immunosuppression sets the body up for many severe con-

ditions down the road, such as, renal failure, osteoporosis,

and diabetes mellitus.

Suppressing the immune system pre-

disposes the body to more pathogens and infections. This

chronic inﬂammatory response allows these microorganisms

to adapt to their surroundings through molecular mimicry. A

thirty-year study published in 2020 showed larval parasites

present in cerebrospinal ﬂuid of the lateral ventricles of

Multiple Sclerosis patients.

Ten out of ten cases found

coenurus parasites.

When these pathogens are not addressed

as a possible root cause as part of a differential diagnosis of

a patient’s problem, further breakdown of the body continues.

NUTRITIONAL DEFICIENCIES

The body’s continued state of inﬂammation induces mal-

absorption and nutritional deﬁciencies. Micronutrient

deﬁciencies due to malnutrition affects over 2 billion people

a year. The greatest micronutrient deﬁciencies are Vitamin A

(VAD), iron, and iodine.

A study from The Department of

Parasitology and Medical Entomology showed that Iron and

VAD deﬁciencies are often present with these stealth infec-

tions.

VAD is a serious threat in 118 countries, placing the

eyesight of about 250 million children at risk. The World

Health Organization (WHO) states that VAD in children is

the most signiﬁcant cause of blindness.

Up to 500,000 VAD

individual cases are recorded each year, with half of those

ending in death.

Anemia impacts about 40 percent of children in develop-

ing countries.

Iron deﬁciency anemia (IDA), in particular, is

recorded as being the most prevalent nutritional deﬁciency

worldwide.

Over 1.8 billion intestinal infections due to these

pathogens are found in countries such as Asia, Africa, and

Latin America. Hookworm infections closely resemble IDA

signs and symptoms. Helminthic infections directly cause

iron deﬁciency anemia by sucking the blood from their host,

lowering iron uptake in the intestine, and interfering with iron

metabolism.

They destruct the mucosal lining of the intes-

tine inﬂuencing absorption of this nutrient. These infections

cause bleeding and dysentery, both of which deplete the body

of more iron stores leading to further anemia.

Iodine is necessary for hormone production. These hor-

mones regulate metabolic functions and play a vital role in

all physiological functions in the body.

The prevalence of

iodine deﬁciency (ID) and these intestinal infections is

astounding. A study published by Cambridge University

Press showed the prevalence of widespread iodine deﬁciency

with high numbers of helminth infection.

After testing a

total of 1,029 children, many were infected with some type

of these microorganisms.

Upon testing for nutritional deﬁ-

ciencies, 100% of the children were iodine deﬁcient, and

80% of them were infected with one or more intestinal par-

asites.

DIAGNOSTICS

Diagnosing these opportunistic pathogens can be compli-

cated. Microorganisms like these can go undetected due to

where they are in their life cycle.

Therefore, linking diag-

nostic tests and labs together with common symptomatology

can allow for a more timely and accurate diagnosis for the

patient.

Seeing trends on speciﬁc labs and listening to patients’

symptoms are key in identifying infections. Some of the most

common signs and symptoms patients can present with when

these microorganisms are present are: eye ﬂoaters, digestive

issues, joint pain, anemia, mood swings, schizophrenia, anx-

iety, depression, OCD, ADD/ADHD, bed wetting, food

sensitivities, and nutrient deﬁciencies. Assessing nutritional

status can be helpful since many of these infections feed off

certain nutrients in the body. Other common signs and symp-

toms seen with these pathogens are insomnia, anal itching,

twitches, teeth grinding, weight gain or weight loss, restless

sleep, sleep disturbances, eczema, rosacea, and seizures.

When practitioners pay attention to symptoms that patients

present with and run key lab markers, a trend will emerge

giving conﬁrmation of a stealth infection. Two of the most

helpful markers to pay attention to in labs are high

eosinophilia count and monocytes.

Optimal range for

eosinophils is less than 3%.

Higher ranges often signifying

microorganisms are present. When monocytes are out of the

optimal range of 4-7% inﬂammation and infection can be

present.

In addition, when alkaline phosphatase markers are

higher than optimal, between 70-100 U/L, inﬂammation is

present.

A higher than normal alkaline phosphatase range

could also be indicative of bone or kidney disease. More clar-

ity and insight is gained when looking at the liver enzymes

AST and ALT alongside bile duct patency. Speciﬁcally, see-

ing an ALT over 26 U/L with an alkaline phosphatase over

100 U/L is a good indication that liver ﬂukes might be at

play.

An optimal globulin range is 2.4-2.8 g/dL.

A range

Parasites

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Nutritional Nutrition Standard Journal

July, 2024 7

over this can be indicative of a few things including stealth

infections. Gamma globulins are increased in the body when

foreign pathogens are present.

Furthermore, when gamma-

glutamyl transferase (GGT) is lower than 13 U/L, alongside

low levels of glutathione, microorganisms need to be consid-

ered.

Glutathione is depleted in the body when there is a

high toxic load from heavy metals, heavy alcohol consump-

tion, and conventionally grown foods. When glutathione is

low in the body, it predisposes the body to oxidative stress,

mold, and pathogens.

When foreign invaders enter the

body, it sets off an immune response. Inﬂammation is a nat-

ural response, however, when left untreated, chronic

inﬂammation will follow leading to many autoimmune dis-

eases, including thyroid conditions. When TSH higher than

2 IU/ml is seen, nutritional deﬁciencies, toxins and infections

like these microorganisms could be at play.

Immunoglobulin E (IgE) markers are elevated during allergic

reactions and immune responses.

Parasitic infections should

be considered when persistent high IgE levels are seen.

solid history including details about travel, geographical loca-

tion, clinical labs, and some of these common symptoms

patients can present with are all vital to accurate diagnosis.

Diagnostic tests can be vital for the diagnosis of an oppor-

tunistic pathogen. Microscopic examination is considered the

“gold standard” when testing for these stealth infections.

However, many false negatives can result from solely relying

on one stool examination when testing for various

pathogens.

Fecal Ova and Parasite Test (O&P) is a visual

inspection under microscopic examination.

Conﬁrmation

by visual microscopic inspection of the stool denotes a pos-

itive test.

However, a negative still leaves room for error.

This could simply be due to no infection present or an insuf-

ﬁcient number of these pathogens present to be detected.

Simply put, a negative test could still mean that opportunistic

pathogens are present due to the fact that some of these

species shed intermittently. Identiﬁcation of which speciﬁc

pathogen is present goes from 60% with a single stool sample

to 95% with 3 stool samples evaluated.

Gastrointestinal

Microbial Assay Plus (GI MAP) tests speciﬁc DNA and has

the capability to detect over forty different organisms includ-

ing bacteria, viruses, fungi, as well as these parasitic

infections. It can also assess many digestive disorders.

MAP can be instrumental for practitioners. This test allows

detection of various pathogens, has the capability to analyze

gut dysfunctions, while also having the ability to develop

accurate treatment protocols.

DISTINGUISHING BETWEEN PARASITIC

INFECTIONS AND OTHER INTESTINAL

INFECTIONS

There are many intestinal infections that can cause gas-

trointestinal (GI) symptoms that often mimic a parasitic

infection. Due to several overlapping symptomatologies,

being able to clearly distinguish common signs and symp-

toms of these intestinal diseases with that of these

microorganisms is important.

Helicobacter pylori (H. pylori) is an intestinal bacterium

that damages the small intestine causing inﬂammation and

redness within the intestinal walls. It is exacerbated by stress

and is the most common cause of a peptic ulcers.

It’s esti-

mated to infect 30-40% of the population in the United

States, 50% of the population worldwide.

Studies show that

long term infection with H. pylori greatly increases the risk

of stomach cancer.

Symptoms of H. pylori are often abdom-

inal pain, weight loss, nausea, vomiting, belching, lack of

appetite and dull stomach pain.

B-12 deﬁciency can often

be seen with H. pylori infections as well.

Small Intestinal

Bacterial Overgrowth (SIBO) is an intestinal infection that

develops when the population of the enteric bacteria are dis-

rupted. This can be caused by many factors but most

commonly by dysmotility of the small intestine and displace-

ment of bacteria normally found in the large intestine now

growing in the small intestine.

Some of the most common

symptoms of SIBO are nausea, vomiting, bloating, and diar-

rhea.

More complicated symptoms from SIBO are nutrient

deﬁciencies such as B-12, and fat-soluble nutrients like A, D,

K and E. These deﬁciencies occur due to deconjugation of

bile salts in the presence of SIBO and H. pylori infection.

Candida Albicans is an opportunistic fungus that lives on the

body. It can be found on the skin, in the mouth and in the

intestines. Ideally a healthy balanced intestinal microbiome

will keep candida in check and keep overgrowth from occur-

ring, but when out of control, things like diaper rash, oral

thrush, and yeast infections can occur.

Symptoms such as

diarrhea and stomach pain are commonly seen with

Candida.

Candida is frequently seen in patients with a

weakened immune system, a chronic illness, or a history of

antibiotic use. These patients are also more susceptible to

Candida entering the bloodstream, causing harm to the brain,

heart, bones, eyes, and blood.

A study by PubMed, showed

mice having an increase in regulatory T cells when the stom-

ach has been colonized by Candida. The important factor

here is regulatory T cells go on to promote further immuno-

suppressive responses within the host.

Candida colonization

within the gut has been associated with several other inﬂam-

matory gastrointestinal diseases. Gastrointestinal diseases

Parasites

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National Nutrition Standard Journal

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like Crohn’s, duodenal and gastric ulcers, and Irritable Bowel

Disease were documented to have high amounts of Candida

colonization thus perpetuating the cascade of inﬂammation.

Inﬂammation can be detrimental to the health of the body

and long-term illness can occur if left untreated.

CONCLUSION

Helminths, protozoans and ectoparasites are extremely

common worldwide and cause an enormous amount of

inﬂammation in the body. Keeping these pathogenic infec-

tions on the list of differential diagnoses will improve patient

outcomes. By having a better understanding about the com-

mon inﬂammatory symptoms these microorganisms cause

and being able to identify the nutritional deﬁciencies seen

with them, practitioners will begin to place these pathogens

as a root cause to their patients' illnesses. This could be instru-

mental in patients’ pursuit of optimal health.

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