Q:For the past few years I've suffered from a number of bowel problems and almost constant fatigue. I've seen allergy doctors and alternative practitioners, who have treated me for possible allergies, candida albicans and ME all to no avail. Any suggestions? B. M., Shropshire.
A:Have you looked into the possibility that your problems may be caused by an intestinal parasite? Allergy specialist Keith Mumby has done a good deal of work on parasites and their treatment. Here is what he had to say:"It is now accepted by many clinical ecologists that as many as one in six people in Britain may be carrying around giardia lamblia, a minute, flagellated protozoan that causes severe fatigue and bowel disturbance. Perhaps 10 to 12 per cent carry cryptosporidia infestation, a mild enough infestation in healthy individuals but a potentially fatal one for those with compromised immunity, such as AIDS victims.
"The majority of patients simply get vague, grumbling symptoms that come and go, never quite adding up to a 'disease' or something the doctor would wish to have fully investigated. Most especially occur in the bowel, where mild symptoms of the 'irritable bowel'type are quite common. However, systemic symptoms particularly fatigue, lack of energy, muscle weakness, headache, sore throats, enlarged lymph glands, night sweats and occasional fever can be caused as well.
"Giardia lamblia is an important cause of traveller's diarrhoea and chronic fatigue. Patients with irritable bowel or ' food allergy' can often date the onset of their symptoms to an episode of tummy upset on a holiday abroad.
"Giardiasis can cause severe malabsorption, not unlike that caused by coeliac disease, and even total atrophy of the gut lining.
"Commonly, patients with giardiasis have a deficiency of the enzyme lactase, required to digest cow's milk, and they may also fail to absorb folic acid and vitamin B12, leading to anaemia.
"At the moment, diagnosis of giardiasis is very difficult, since most labs do not have the requisite detection skills. Routine hospital screening of faeces for the presence of giardiasis misses the diagnosis 98 per cent of the time.
"A newer and probably better method, described by Bueno and Parrish in the USA, consists of a superficial biopsy of rectal mucosa taken by means of a small cotton bud swab pressed firmly into the mucosal lining.
"There are various other, less common parasites, and because of the deplorable state of diagnostic techniques, doctors like myself consider it a good idea when parasites are the likely culprit of a complaint to try a therapeutic trial of treatment to see if it helps.
"For many of these organisms, the metronidazoles (Flagyl) are the treatment of first choice. Therapy may need to be kept up for several weeks. Even if apparently successful, relapses are common, probably due to incomplete eradication, rather than re infection.
"A new drug, tinadazole (Fasigyn) has become available and appears to be effective. Nevertheless, it may cause short lived abdominal discomfort and drowsiness. Treatment should be avoided during pregnancy and breastfeeding, and patients under treatment should avoid alcohol, which will make them ill if taken concurrently with the drug.
"Herbal treatment can be strikingly effective, particularly plants from the genus Artemesia. These are the worts, such as wormwood (Artemesia absinthium) and mugwort (Artemesia vulgaris). Moxa, used in moxybustion by acupuncturists, is from this group of plants.
"Best known as an antiparasitic is Artemesia annua. It is currently under study by the WHO as a possible treatment for chloroquine resistant malaria. It is available as a bowel preparation; usually, 1 gram is taken three times a day for 60-90 days. Better results may come from combining it with some other herbs.
"Grapefruit seed extract, known under several brand names such as DF/100, Parcan and Citrocida, has a similar range of activity. The two combine very well. If a short term course of Flagyl is added, this makes up just about the best ammunition we've got."
"If a doctor diagnoses you as having a parasite and you respond to treatment, it is vital to investigate other members of your family to prevent cross infection.
"In the UK, rectal swabs and the Bueno-Parrish method can be done at the London Clinic, 20 Devonshire Pl, London WDN 2DH (tel: 071 723 6581)."