It's not a new idea. Physicians and medical researchers have been making the connection between problematic intestinal flora and arthritis and other rheumatoid conditions since the early 20th century.
"Arthritis is well known as a complication of a few tropical diseases . . . [such as] bacillary dysentery and fungus infections," wrote Drs Julia Morgan and Bernard Comroe in their article 'A Brief Review of Arthritis and Allied Conditions in Tropical Diseases', which appeared in the Annals of Internal Medicine in 1946.
And then in 1975, at the IXth International Chemotherapy Congress in London, the late microbiologist Roger Wyburn-Mason (MD, PhD) dropped a medical bombshell by announcing he'd discovered that protozoa-one or more species of Naegleria-were the cause of rheumatic disease. The findings of this Mayo Clinic researcher and Yale professor were never verified, even though his dietary protocol for rheumatoid arthritis (RA), employed by doctors such as Jack M. Blount, MD, and Gus J. Prosch Jr, MD, of the Arthritis Trust of America, was said to mitigate or cure many thousands of people suffering from RA.
In the 1990s, the connection between gut flora and a multitude of autoimmune disorders such as RA, systemic lupus, type 1 diabetes, Crohn's disease and inflammatory bowel disease (IBD) became not only respectable lines of research, but promising ones. Papers with titles like 'Early-onset polyarthritis as presenting feature of intestinal infection with Strongyloides stercoralis', published in 2003 by the British Society for Rheumatology, were popping up more regularly.
But it wasn't until 2013 that Frank Lipman, MD, a practitioner in New York City who regularly treats celebrities like Arianna Huffington, Gwyneth Paltrow and Donna Karan, went high profile, with articles about his patient Seamus Mullen, an acclaimed NYC restaurateur, cropping up in publications like Men's Journal, The New York Times and The Telegraph, that the link between RA and parasites became popularized.
Diagnosed with rheumatoid arthritis in 2007, Mullen ended up in Lipman's offices tired, overweight and in chronic pain. Lipman treated him for autoimmune problems and, discovering he suffered from parasitic infections, also went to work to heal and stabilize his microbiome-the systemic microbial population in his body-with diet, pharmaceuticals and then herbs.
"I have seen hundreds of patients with systemic arthritic problems over the years who have responded," says Lipman. "Depending on the severity, it can take many months [to heal]. For instance, Seamus Mullen took at least six months. But if it is not severe and you catch it early, within one month, patients feel significantly better."
Lipman, who combines Western medicine with alternative therapies and a heavy emphasis on a healthy diet eliminating all processed foods and sugars, says a dysbiosis or altered microbiome seems to cause systemic inflammatory problems and often autoimmune issues. Correcting the microbiome and creating more balance may involve treating parasites, 'bad' bacteria or yeast, and often a combination of all three.
"I always start with diet," he says, "removing proinflammatory foods or foods that are hard to digest or may be triggering inflammation. Then I add probiotics and nutrients to help with healing the lining of the gut. Unfortunately, at this stage, we are guessing what to use to kill the pathogens, as there are no accurate tests to ascertain which particular bugs are causing the problem. So I always start with herbal antimicrobials and if those don't work, I move on to pharmaceutical antiparasitics or antifungals or antibiotics."
Today, patients like Mullen are living proof that this treatment approach to RA-the same approach Wyburn-Mason was using back in the 1970s-is highly effective. Lipman is happy to say there are now no RA markers in Mullen's blood, that his joints are healthy, and that he is pain-free and feeling great.
They're everywhereNew studies linking gut health and rheumatoid arthritis are being conducted with greater and greater frequency. For example, researchers at the New York University School of Medicine, funded in part by the US National Institutes of Health (NIH) National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Human Genome Research Institute, recently discovered that 75 per cent of people with new-onset, untreated RA had Prevotella copri bacteria in their intestinal tracts, as well as reductions in several groups of beneficial microbes such as Bacteroides.
A direct causal link between P. copri and RA has yet to be proven, but continued studies are underway looking for the connection. Humans and microbes have coexisted for millions of years, and tens of trillions of microbes live in the human body. There are actually more bacterial cells than human cells in our bodies, busily doing everything from helping to guard against infection to assisting in digestion. Major efforts such as the NIH's Human Microbiome Project (see www.hmpdacc.org) have been initiated to better understand the role microbial communities play in the human body. The HMP is also looking for links between alterations in this ancient microbiome and human health.
Probiotic therapies have been proposed for a wide range of gut-related disorders, including irritable bowel syndrome (IBS). And several studies now suggest that faecal transplantation may be beneficial in cases of antibiotic-associated diarrhoea and Clostridium difficile infection. This is all adding up to a major change in scientific interest about the importance and overall role these little-understood internal companions play in our lives.
Prevalent infectionsUS Centers for Disease Control and Prevention (CDC) director Tom Frieden, MD, MPH, says parasites are more common in developed countries like the US and UK than people realize. Recent estimates suggest that Ascaris lumbricoides can infect over a billion people, Trichuris trichiura, 795 million, and hookworms, 740 million people. "Parasitic infections, caused by intestinal helminths and protozoan parasites, are among the most prevalent infections in humans in developing countries," says Rashidul Haque, head of the Parasitology Laboratory in Bangladesh.
The World Health Organization (WHO) estimates some 50 million people worldwide are subject to amoebic infections each year, with around 40,000 to 100,000 deaths every year because of these infections. These facts are as inescapable as the parasites themselves.
We live in a global society and our parasite companions go global right along with us, easily transmitted by eating fruit from South America and China, using public toilets and even receiving blood transfusions. American troops returning from Desert Storm were told they shouldn't donate blood because of the parasitic disease leishmaniasis, spread by desert sand flies.
We love our pets, and it's distressing to think of them as possible carriers of disease. Yet, an estimated 45 per cent of all dogs and 62 per cent of domestic cats sleep in bed with their owners, exposing humans to dozens of diseases from leptospirosis and hookworms to salmonellosis and toxoplasmosis. In 2012, a case of reactive arthritis due to a protozoan was cited in the report 'Reactive arthritis caused by Blastocystis hominis' in Reumatologia Clinica.
Blastocystis hominis is transmitted between animals and humans through the ingestion of cysts in the water supply. This particular case report described a healthy 45-year-old Spanish woman who sought treatment for joint and back pain, arthritis only in her left knee, and pain and redness in one eye.
Previously, she had taken many trips to places like India, Nepal, Kenya, Tanzania and Burma, and had traveled to Egypt that year. Although her medical history revealed a recurring tapeworm infection and B. hominis in a stool sample, her joint fluid and blood cultures, urine cultures and stool cultures were all negative for bacteria and parasites, and blood tests for rheumatoid factor were negative.
She was, however, HLA-B27-positive-a test that frequently indicates ankylosing spondylitis, a chronic inflammatory disease affecting joints of the spine. Between that and the eye infection, reactive arthritis due to B. hominis was diagnosed and she was successfully treated. Roundworms (nematodes) are also commonly passed from animals to humans. Threadworms (passed between humans and from humans to animals, and then back to humans again) are estimated to infect over 100 million people worldwide.
VU University Medical Center researchers in Amsterdam have discovered that S. stercoralis (roundworms) can remain in the body undetected for years until the host's immune system is compromised by either disease or corticosteroids, at which time these nematodes proliferate wildly and rheumatoid symptoms arise. In one case study investigated by these researchers, a 35-year-old man was hospitalized with arthralgia (joint pain) that got worse, despite treatment with non-steroidal anti-inflammatory drugs (NSAIDs). He had no rheumatoid factors in his blood, and it was only after repeated stool tests that larvae were detected and he was successfully treated.
A difficult diagnosisExactly how arthritis develops from parasitic infections is unclear. Spanish researchers say there are various ways B. hominis and other parasites might cause joint disease. There could be "local invasion from neighbouring bones or muscles via the blood or lymphatics with the presence of adult individuals, larvae or eggs in the joint cavity. They could also trigger a reactive inflammatory reaction to the presence of the parasite in the surrounding tissue, without an actual joint invasion."
Strongyloides larvae were found in a synovial biopsy (taken from the synovium, the membrane lining joints), which suggests an infectious type of arthritis. But the authors of the report considered this a case of "reactive arthritis" in response to infection by the large numbers of larvae distributed throughout the body.
What exactly is reactive arthritis? It's defined as an acute arthritis caused by an enteric (gut) or genitourinary infection that generally starts in the body about a month prior to the onset of arthritis itself. Evidence of infection is considered a primary feature of reactive arthritis, as is acute enthesitis (inflammation where tendons and ligaments attach to bone).
Reactive arthritis is most commonly seen in the presence of Salmonella, Shigella, Chlamydia, Yersinia and Campylobacter, as well as other microorganisms such as Giardia lamblia, Entamoeba histolytica, Trichomonas vaginalis and Toxoplasma gondii. Modern Western doctors have little or no understanding of parasitology, little familiarity with tropical diseases, and are usually unaware of the vast numbers of microorganisms and parasitic diseases that plague Western populations.
If a stool test is done, the results are frequently misleading. In the two case studies mentioned above, multiple stool tests were conducted, but came up negative. The reason is simple: when parasites lay their eggs, they hatch in cycles, so eggs don't always show up in samples. And some parasites lodge in the upper gastrointestinal (GI) tract, from where it's often difficult to find indicators of their presence. Other parasites lodge in muscles and tissues, and never show up in stool tests at all.
Traditional treatment can send patients over the edgePatients diagnosed with RA and other rheumatic conditions are normally urged by physicians to start treatment early with antirheumatic drugs, which include corticosteroids and tumour necrosis factor (TNF)-blockers. Unfortunately, in cases involving parasites, such treatments can themselves trigger the onset of arthritis or make an existing condition worse. "To prevent a life-threatening outcome, however, some rare infections [such as with Strongyloides] have to be excluded" from this kind of approach altogether, say the VU researchers in Amsterdam.
Treatment with corticosteroids or cytostatic agents (which stop cell growth) could lead to an "overwhelming systemic parasitic load", resulting in a "serious medical condition called 'hyperinfection syndrome', or disseminated strongyloidiasis may develop rapidly . . . characterized by pneumonitis, respiratory failure, cerebral infiltration and a high mortality rate."
Not only can traditional arthritis treatments set the stage for arthritis and severe complications if parasites are present, but they can also kill off the good microbes that directly aid human health. For example, the decline of the bacteria Helicobacter pylori in developed countries from the overuse of antibiotics has been linked to an increased risk of asthma.
There are even cases now where the introduction of certain parasites, such as helminths (worms), is being tested for possible use as a treatment for IBS, IBD and other inflammatory conditions. Researchers believe that byproducts secreted by parasites might directly modulate human immune function and that the immune responses so triggered "could counteract the immunopathological reactions that drive autoimmune diseases".
Who would have thought that 150 years after the work of Dr Ignaz Semmelweis, Louis Pasteur and Robert Koch, and the acceptance of the germ theory of disease, we would end up full circle embracing the world of bacteria and other microbes as healing agents and potential life-savers?
When to suspect that you have parasites
We can carry parasites in our intestines for years and never know it, although passing worms or eggs in stool is an obvious sign.
Other physical symptoms are:
o Gas or bloating
o Abdominal pain
o Blood and/or mucus in stools
o Itching around the rectum or vulva
o Unexplained weight loss or inability to lose weight.
Testing for parasitesThe most common intestinal parasites are Cryptosporidium spp, Cyclospora cayetanenensis, Giardia lamblia and Entamoeba histolytica, and all four are commonly associated with diarrhoea. If you suspect parasites, remember, a one-off stool test is unlikely to give you an accurate reading of the parasites you might be harbouring.
In addition to regular stool tests, some doctors use what's termed a 'purged stool test', which uses a strong laxative to ensure a more accurate reading, especially if there's the possibility of amoebic infestation, giardiasis, roundworms, threadworms, tapeworms, flukes, cryptosporidia and hookworms. But be sure to let your health practitioner know if you're pregnant or have high blood pressure, as this could be a contraindication for a purged stool test.
Rectal mucus samples are also highly recommended for getting an accurate reading. According to A.L. Gittleman, author of the popular book on parasites and their treatment, Guess What Came to Dinner?, when proper tests are done, as much as 50 per cent of inflammatory bowel diagnoses were proved wrong, with patients suffering from giardiasis instead.
Blood tests will usually show an elevated white blood cell (eosinophil) count when parasites are present, except in cases of Giardia and amoebic conditions. They can also show specific antibodies to certain parasites like Strongyloides and Toxoplasma gondii, unless the patient already has a compromised
Giardiasis can also be diagnosed by detecting Giardia antigen in stools, just as cryptosporidiosis is indicated by the presence of Cryptosporidium antigen in faecal samples. Antigen-detection tests are now commercially available for all three major intestinal protozoan parasites.
Diagnostic laboratoriesGenova Diagnostics in the UK is a speciality clinical laboratory that requests at least three stool samples in its stool test kit. Ask your health practitioner to get the kit, then send the test stool samples to (www.gdx.net/uk). Genova also operates in the US (www.gdx.net). The Jetti Katz Tropical Medicine Lab in New York provides the same service (www.jettikatzlab.com). In Australia, contact Cellabs, based in Sydney (www.cellabs.com.au).
Massage therapist clears up RA with diet
"I was shocked to be diagnosed with rheumatoid arthritis," says Kathy Lund, a licensed massage therapist based near Olympia, Washington in the US. "That's a big deal. I could be debilitated." At age 58 she also was diagnosed with irritable bowel syndrome (IBS) and Candida as well as the Epstein-Barr virus.
Advised to take a dietary approach to healing, her doctor recommended lots of fresh organic vegetables, some fruits, chicken and fish. That was it. "I couldn't have sugar or caffeine, no red meat, no dairy, no corn, no soy, no milk and no wheat, and of course, no processed foods." After she left his office, she went home and filled three big black garbage bags with all the boxed food items in her cupboard and all the packaged foods in her refrigerator. "And then I stood there and wondered, 'What can I eat?'
"It was really upsetting and scary. I had no clue how to feed myself. At that point I was eating pasta and lots of bread and wine-I'm from Napa Valley, California, and we all eat like that there-so it was a whole food re-education programme." It's been quite a journey, learning to understand how her body works, and how an healthy gut and stomach bacteria would overcome the Candida and IBS. "I took probiotics for a couple of years and that finally took care of the nasty bacteria in my stomach. I also took mastic tree resin for the irritable bowel syndrome."
About a year and a half after the initial diagnosis, Kathy was retested for rheumatoid arthritis along with 10 other autoimmune diseases, and the results were completely negative. "I know I'm not healed," she says. "This will be with me for the rest of my life."
She says she knows it's up to her to learn what activates the symptoms and to eat wisely and well. She started testing and eating things that had been off her diet plan to see what she could reintroduce into her diet, and had a flare up. Sugar, she has discovered, is an absolute no-no, as is gluten. "I can't believe I thought what I was eating before was healthy," she says. "It wasn't. I'm so much better now and there's no going back, ever."
Your 4-step programmeThis anti-parasite plan has helped many beat arthritis for good
Step 1: Adopt a healing dietChanging your diet is at the top of the to-do list when it comes to stabilizing and improving gut flora, and mitigating the inflammation of arthritis.
o Follow a low-inflammation diet and eat lots of inflammation-reducing vegetables and fruits like broccoli, leafy greens and brightly coloured vegetables, yams and sweet potatoes. Eat deep-water fish like salmon, cod and halibut, as well as organic chicken and turkey. Eat berries (especially strawberries, blueberries and raspberries, and tart cherries) as well as apples, bananas and mangoes, but avoid highly acidic fruits.
oEliminate all processed foods, fried foods, sugar, soy products and gluten, artificial sweeteners, MSG, artificial additives, corn, hydrogenated vegetable oils and all soda drinks.
o Eliminate red meat, dairy, alcohol, cereals, breads, pastas and caffeine.
o Go organic.
oCook with extra virgin olive oil (organic) for low-heat cooking, and organic coconut oil, avocado oil, butter (organic), ghee or lard for high-heat cooking.
oBalance your omega-6 to omega-3 fatty acids with an approximately 4 : 1 ratio.
oInclude probiotics like homemade unsweetened kefir made from whole unpasteurized milk, not the sweetened commercial brands. Eat probiotic-rich yoghurt (unsweetened) containing live Lactobacillus, and fermented foods like sauerkraut to help reestablish healthy gut flora after a course of antibiotics or other medications.
Step 2: Cleanse yourself of parasitesIf you suspect parasites, don't think you have to go the pharmaceutical route immediately to get results. Many herbal remedies are powerful parasite cleansers. Still, it's always best to find a local health practitioner familiar with parasitic disorders and parasite cleanses (such as a naturopath) to help you get rid of them.
In the meantime, here are a few commonly found natural agents that can treat parasitic infestations.
Artemisia annua (sweet wormwood) is an antimalarial herb, and its active ingredient artemisinin has proved promising against schistosomiasis and clonorchiasis, which are caused by trematodes (blood flukes). It is often used in combination with praziquantel.
Artemisia absinthium (common wormwood) is often used with black walnut tincture (see below) to kill parasites in both larval and adult stages. Do not use if pregnant or nursing, or if allergic to plants in the daisy family.
Suggested daily dose: 1-3 260-mg capsules with food
Berberis vulgaris (barberry) and its active constituent berberine are effective for bacterial/viral infections, candidiasis, yeast and urinary tract/bladder infections.
Suggested daily dose: 1 500-mg capsule daily or as directed by a healthcare professional
Black walnut tincture can treat parasitic worm infections, diphtheria and syphilis.
Suggested daily dose: this varies, from 1 drop in 1/2 cup of water up to 2 1/2 tsp in 1/4 cup of water
Caprylic acid is a medium-chain fatty acid found in coconut oil and commonly used in patients with dysbiosis, especially with a fungal/yeast component.
Suggested daily dose: 1-3 Tbsp of coconut oil for fungal infections. Note: taking too much too quickly can cause intense dizziness and body flushing, so start with 1/2 tsp and work up to the usual dose; best taken with or after meals. As capsules (Caprin), 1-3 capsules with each meal, commonly taken with garlic (1-3 500-mg capsules with each meal) and emulsified oil of oregano (ADP), 1 tablet with meals and at bedtime.
Cranberry as raw cranberry juice (unsweetened) is a highly regarded home remedy for urinary tract infections (UTIs). The American College of Obstetrics and Gynecology states that drinking unsweetened cranberry juice can reduce UTI symptoms.
Hypericum perforatum (St John's wort) can treat parasites and bladder infections as well as diarrhoea, but first check with a physician if you're pregnant or lactating, or taking antidepressants, drugs to prevent transplant rejection, the Pill, heart medications or drugs for HIV.
Suggested daily dose: 15-40 mL per week as 1 : 2 fluid extract
The anti-parasite recipeIf you test positive for parasites, our Medical Detective Harald Gaier regularly uses the following formula, which can kill most parasites after around six months.
On weeks 1 and 3, take:
Berberis vulgaris tincture (15 mL three times a day)Oregano oil (1 capsule a day) to inhibit parasites like Giardia
Artemisia absinthium tincture (15 mL three times a day)
Clove powder (1 capsule a day)
On weeks 2 and 4, take:
Hydrastis canadensis (goldenseal) tincture (15 mL three times a day)
Olive leaf extract (1 capsule a day)
L-Glutamine (5 g/day)
Berberis and Artemisia attack all manner of gut bacteria, protozoans and yeasts. You can also add propolis supplements, which work well against Giardia. According to Essex-based medical herbalist Susan Koten, consider seeing a herbalist about a gallbladder flush comprising fringetree (Chionanthus virginicus), Culver's root (Leptandra virginica) and B. vulgaris, as the gallbladder is often also affected.
Step 3: Re-establish good gut healthEnsure the long-term health and stability of your gut flora following a parasite cleanse (or after taking courses of antibiotics and other medications) by regularly taking probiotics. Although they can be introduced through supplements, it's far better to get your probiotics through natural food products-and homemade wins over commercial brands every time.
Homemade kefir, for example, is believed to contain around 60 different strains of probiotics vs commercial (sweetened and pasteurized) brands, with only around 10 kinds of probiotics.
Lactobacillus acidophilus helps balance gut flora to maintain a healthy defense against parasites.
Bifidobacteria help balance bacterial populations in the body, and can help prevent the spread of unhealthy bacteria and yeast.
Suggested daily dosages: 1-15 billion colony-forming units (CFUs) to maintain a healthy gut; 1-2 billion up to 10-15 billion CFUs to prevent or treat diarrhoea; for antibiotic-related diarrhoea, take a dose two to three hours after the antibiotic
Saccharomyces boulardii is commonly used to improve intestinal microflora and to ease conditions like acute diarrhoea, irritable bowel syndrome and inflammatory bowel disease.
Suggested daily dosage: 235 mg one to three times a day
Step 4: Eliminate CandidaOvergrowth of the normally harmless Candida fungal yeast can wreak untold havoc in the gut. But Candida may be only one of several culprits, and so-called candidiasis sufferers may have several, quite distinct problems, including those mentioned in this article. If you don't improve on a Paleo (Stone Age) diet, essentially the same as the anti-inflammatory diet described here (except that the Paleo diet includes red meat and hot spices, no-nos for inflammation), then definitely suspect Candida.
Get a gut fermentation test. This measures the presence of ethyl alcohol in your gut after consuming glucose sugar, as often happens with yeast overgrowth, and so distinguishes yeast from bacterial overgrowth. The test can be done by Biolab (see below). In North America, Genova Labs offers a Candida antibody test, a simple saliva test that can confirm whether it's Candida or not.
Do a Candida cleanse with a natural antifungal like barberry (Berberis) tincture. Also, caprylic acid, goldenseal and a number of other traditional treatments are promising, such as tea tree (Melaleuca alternifolia), oregano, olive and clove
oils (see Step 1).
Suggested dosage: 15 mL twice a day of Berberis tincture
Follow a low-carb diet and avoid sugar, yeast, alcohol and the usual allergy-related foods and, for a week or two, fruit. Check your nutritional status and take supplements if necessary. Doctors on our panel find their patients are usually deficient in magnesium, zinc, vitamins A, B1 and B6, and omega-6 fatty acids.
Take pancreatic enzymes (proteases) to keep the small intestine free of parasites and to aid digestion. A lack of protease greatly increases the chances of gut infections, including chronic candidiasis. Add supplements of choline, betaine and methionine to clean up your liver, as mild liver damage is often behind chronic Candida overgrowth. These liver enzymes also boost your levels of two important antioxidants: S-adenosylmethionine and glutathione.
Milk thistle (Silybum marianum) extract can stimulate the formation of new liver cells and increase glutathione and bile production. It can also reduce liver damage.
Suggested dosage: 70-210 mg three times a day
REFERENCES: MAIN TEXT
1 Ann Intern Med, 1946; 24: 233-40
2 Torgan C. 'Gut Microbes Linked to Rheumatoid Arthritis'. NIH Research Matters, November 25, 2013
3 Genome Med, 2011, 3: 14
4 J Health Popul Nutr, 2007; 25: 387-91
5 Reumatol Clin, 2012; 8: 50-1
6 Rheumatology, 2003; 42: 1419-20
7 J Parasitol Res, 2011; 2011: Article ID 942616, 8 pages
REFERENCES: CLEANSE YOURSELF OF PARASITES
1 Dharmananda S. 'Ching-Hao and the Artemisias Used in Chinese Medicine', 2002; www.itmonline.org/arts/chinghao.htm