Review of Parasites and their Treatments

How to safely and effectively get rid of parasites

Disclaimer: I am a physician for 25+ years, and I’ve worked on establishing clinical practice guidelines for numerous healthcare entities (insurers and hospitals) as part of my career. Having said that, I’m not your personal physician. I believe that each person deserves personalized care based on their symptoms, test results, presence or absence of risk factors associated with parasites, diet and lifestyle, personal & family history, etc. This post is to provide you with the necessary information about 2 types of parasites: protozoa and helminths (worms). Compared to many countries who have many risk factors, including their environment and contaminated food/water supplies, the US nearly does not have the number of parasitic infections than they do. However, recent surge of illnesses, rise in inflammatory bowel disease and auto-immune disorders, association of parasites with cancers, and the fact that COVID was treatable by anti-parasitic drugs, people are reevaluating whether ‘parasites’ are a real problem in the US as well. For this reason, the information provided below, should help one evaluate their own risk so that they can determine the need for treatment and/or a cleanse, with their physician’s guidance. Please keep in mind the following:

1. While i’ve tried to make it a thorough review, there are numerous parasites. There maybe some missing, either because they don’t infect humans, or there were no recommended treatments found for them. Feel free to add comments if I missed any that you want more information on.

2. This review does not cover fungal infections or viral infections. Many viruses are known to cause cancers as well, such as, EBV, HPV, HCV, etc. They have their own treatment protocols.

3. I’ve included recommended treatments based on review of multiple sources. If there is new evidence that supports the use of a drug for a parasite that I have not listed, feel free to add in comments, so I can review the study and add to the recommendations.

What are Parasites?

Parasites require a host to survive and spread. The adult forms of parasites live and feed from within the host (animals, humans). The eggs and larvae are what ‘spread’ through various means (food, water, flies, bugs and mosquitos). Most parasites, go undetected, and people are ‘asymptomatic’ because the parasite does not disturb the environment. Sometimes, there are slight symptomatic changes, but the person doesn’t think of them as worm related. For example, feeling more hungry, desiring more sweet foods, bloating or indigestion, abdominal discomfort or pain if you don’t eat, and general fatigue and malaise. These maybe signals sent by the parasite, so you take the actions that benefit them, i.e. survive, and have a constant source of food.

General To-Do’s and Not-To-Do’s about Parasites

Here are some To-Do’s:

• Vitamin rich foods or supplements:

  • Carrots, sweet potatoes, and squash are high in beta-carotene, which turns into Vitamin A, which helps to resist parasitic worms and larvae.

  • Eat foods rich in Vitamins C & B

    • B12 is depleted by many worms

    • Folic acid (Vitamin B9) also depletes from malabsorption due to worms

• Minerals such Selenium and Zinc: Selenium and Zinc are required for immune function and resistance to infection

• Include more garlic in your meals: raw garlic has sulfur containing amino acids that are anti-parasitic

• Ensure you have “good” bacteria in your gut by taking probiotics or eating probiotic rich foods like yogurt. (see below regarding probiotics used for natural treatment and prevention of parasites)

• Perform ‘gut cleansing’, such as with psyllium, beetroot, flaxseeds or supplements containing Senna

• Wash all foods well, including vegetables and fruits, prior to use

Here are some Not-To-Do’s:

• Don’t eat raw or undercooked meats, fish, crustaceans, and snails

• Avoid coming in contact with any animal feces or saliva, including from pets

• Avoid coffee, sugar, alcohol, and refined grains

More information on natural prevention and treatments is provided later.

Anti-Parasitic Treatments

Parasites can be treated both naturally and with anti-parasitic medications. Natural herbs and supplements can help maintain an internal environment that prevents parasitic infections in the first place. Some herbs and supplements however, do directly reduce adult worms and egg count. But the effectiveness rate is not as high as anti-parasitic medications that have very targeted mechanism of action. More on natural treatments later.

You are likely to come across Ivermectin, Fenbendazole, Doxycycline and others drugs as treatments. Febendazole is a benzimidazole, and is just one of many other benzimidazoles available, such as albendazole, parbendazole, mebendazole, flubendazole, etc. It is a common practice for drug manufacturers to make different compounds under the same class of drugs, and those products are used in different markets and for different purposes such as animal vs. human use. Fenbendazole is used with animals and majority of data and studies on this drug are from animal studies. So while fenbendazole and albendazole are the same class of drugs, albendazole is a product recommended for use in humans but requires prescription, whereas fenbendazole is over the counter for animal use. What matters most is whether fenbendazole and albendazole have the same level of efficacy. Based on a review of many comparative studies, the efficacies vary based on parasite type. One was superior than the other in each study, but all were animal models. Efficacy studies on humans are available for albendazole, mebendazole, flubendazole, triclabendazole etc. Below, when discussing each parasite and treatment, you will notice that albendazole was recommended as ‘drug of choice’ for many parasites due to higher efficacy, compared to mebendazole, flubendazole and other benzimidazoles. Therefore, these drugs do not all work equally in terms of efficacy.

My review below is based on studied, recommended and approved drugs for the treatment of each parasite in humans.

Drug of Choice (DOC) designation

When there are many drug types to treat an illness, there is usually one drug or regimen that will be considered “drug of choice”. Drug of choice is the go-to-drug, recommended for the highest ‘efficacy’ and safety profile. In the tables below, when you see “DOC”, this it the drug recommended for that parasite. But, i’ve also provided the alternative treatment options that have been studied, along with drugs that were studied but were found to be ineffective.

Parasites and Cancer

I will spare you the detailed explanation of how benzimidazole drugs have anti-cancer properties. If you are interested in the details, here is a good article to read.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9978992/

However, what is clear is that there is a link between certain parasites and certain type of cancers. Literature review revealed many case studies, where people were found to have a certain cancer type, along with the presence of a parasite, and when the parasite was treated, the cancer went into remission. In the review below, i’ve provided the cancers found associated with each parasite. The treatments recommended however, are NOT to treat the cancer. Treatment is to treat the parasitic infection. Further study is required to determine what drug regimens, and duration of treatment is required once a cancer starts, where a parasite is determined to be the cause. Would an anti-parasitic suffice, or additional drugs are required. But in theory, if the parasite is eliminated that was causing the cancer, the cancer should go into remission.

In the review below, under the “associated cancer” column, you will notice that there are certain parasitic infections that “mimic” a cancer. For example, the Anisakis roundworm mimics gynecologic and metastatic liver tumor. These are situations where Radiology imaging revealed a mass that appears to be a tumor, but when biopsied, or surgery is performed to remove the tumor, the parasitic infection is noted. This is an important point for physicians to consider as part of their differential diagnosis when imaging for suspicion of tumor/cancer is performed.

Abbreviations

Please note, that in the treatment column, certain abbreviations are used such as QD, BID, TID etc. Definitions for these abbreviations are provided below.

Color coding

The summary drug treatment tables below are color coded. Please use the following table to understand what the color coding means.

Let’s start with the review of the parasites.

PROTOZOA

Protozoa are single-celled, and are either free-living or parasitic. They lack cell walls which is found in plants and fungi, but they move and are predators of their hosts, so they are believed to have more ‘animal’ like behavior, hence the name protozoa, which means ‘first animals’.

Below is a review of each protozoa parasite.

Summary of Treatments and Recommendations for Protozoa

Below is a color -coded table showing all the drugs recommended for each protozoan infection. There is a large number of anti-protozoan drugs used in the protocols above. The purpose of the table, is to identify any patterns where one drug can deliver the benefit of eliminating multiple protozoa, especially those that affect humans. Drug(s) that eliminate multiple parasites, will be recommended for a “cleanse”. Whereas, I maintain that if there is a proven infection of a specific parasite, then you should follow the full protocol suggested for that parasite.

Anti-protozoan Drugs

Please use the slide below for the ‘drug’ codes used in the color-coded table.

Anti-Protozoan Therapy recommendations

1. Trichomonas vaginalis, Entamoeba histolytica, and Giardia duodenalis can be addressed by one drug: Metronidazole 500 mg TID x 14 days

2. Acanthamoeba, Naegleria fowleri and Leishmaniasis infection are recommended to be treated with L-AmB (Amphotericin B) which is given Intravenously (IV). There is no current oral formulation, although solid lipid nanoparticles loaded with Amphotericin are under development for administering orally. Other oral drugs are still being studied for these parasites, including miltefosine and voriconazole. Voriconazole has shown in vitro activity against each of the 3 infections and maybe an option. I would consider treating these parasites only if at risk or with confirmed infection by testing.

• L-AmB (Amphotericin B) 3 mg/kg/day IV on days 1–5, 14, and 21 (total dose, 21mg/kg) OR

• Voriconazole 200mg BID x 6 weeks (oral) - under investigation

3. Malaria (plasmodium) is very common in certain countries, but not a disease that occurs frequently in the US. Approximately 2000 cases of malaria per year in the US are mostly due to travel. This is another infection I recommend to get tested for, confirm, before treating. Two recommended treatment options would be:

• Chloroquine phosphate (CQ): Day 1: 10 mg base/kg; Day 2: 10 mg base/kg; Day 3: 5 mg base/kg OR

• Atovoquone- Proguanil (Malarone): take 1 tablet per day if traveling to a malaria region. Start taking it 2 days before travel, and continue for 7 days after returning from travel.

4. Finally, Toxoplasmosis treatment is recommended if symptomatic, confirmed by tests, or there is a severe disseminated infection. Protocol is:

• Pyrimethamine 200mg loading dose x day 1 THEN 50-75mg/day x 6 weeks PLUS

• Sulfadiazine 1-1.5 g/kg QID PLUS

• Folinic Acid (Leucovorin) 10-25 mg/day to prevent hematologic toxicity of pyrimethamine

HELMINTHS

Helminths are parasitic worms. They infect the gastrointestinal tract. While others directly infect the blood such as schistosomes. There are 3 types of helminths:

1. Nematodes: includes roundworms (including whipworm, hookworm), pinworms (or threadworms), and filarial worms.

2. Cestodes: are tape worms, the largest of the parasitic worms

3. Trematodes: are the flukes that affect different parts of the body such as liver, lung, intestines, blood and bile ducts.

Treatment strategy for helminths targets both adult worms, as well as their eggs and larvae. Below is a review of each helminth parasite.

Summary of Treatments and Recommendations for Helminths

Below is a color -coded table showing all the drugs recommended for each helminth infection. Once again, we will identify any patterns where one drug can deliver the benefit of eliminating multiple helminth parasites, especially those that affect humans. Drug(s) that eliminate multiple parasites, will be recommended for a “cleanse”.

Anti-Helminthic Drugs

Please use the slide below for the ‘drug’ codes used in the color-coded table.

Anti-Helminthic Therapy Recommendations

1. There is one drug recommendation that stands out, as it is the drug of choice for many of the worm infections. Albendazole is part of the treatment strategy for the following parasites: Ascaris, Anisakis, Trichuris, Ancylostoma Hookworm Toxocara, Gnathostoma, Trichinella, Strongyloides, Angiostrongylus, Raccoon roundworm, Enterobius, Wuchereria, Loa loa, Taenia tapeworm, Echinococcosis granulosus, Echinococcosis multilocularis, Hymenolepis, and Opisthorchis. The dose and duration that covers all of the above infections is:

   1. Albendazole 400 mg BID x 30 days

   2. Albendazole must be taken with a fatty meal to cross blood-brain barrier (if you have any neurologic symptoms listed for each parasite above). If not targeting neurologic symptoms, Albendazole still should be taken with or right after food.

   3. Many of the worms, especially the tape worms, cause B12 and Folic Acid (B9) deficiency, and hookworms can cause iron-deficiency. Supplementing iron, B12, and folic acid is important during treatment and cleanse.

2. The following parasites, Strongyloides, Onchocerca, Mansonella ozzardi, Mansonella streptocerca, share Ivermectin as their drug of choice for treatment. The dosage and duration that covers all of these parasites is:

   1. Ivermectin 200 mcg/kg x 2 days (mcg = microgram). 1000 mcg = 1 mg, so 200 mcg = 0.2 mg / kg. Example: A 60kg person would take 12 mg dose each day for 2 days.

3. Praziquantel is the drug of choice for tapeworms Taenia tapeworm, Dibothriocephalus, Hymenolepis, Spirometra, Clonorchis, Fasciolopsis, Paragonimus, Opisthorchis, Schistosoma haematobium, Schistosoma japonicum, and Schistosoma mansoni. Praziquantel dosage and duration that covers all of the parasites above is:

   1. Praziquantel 25mg/kg TID x 3 days OR Praziquantel 25mg/kg TID x 10 days to cover Spirometra

4. Mansonella perstans, found mainly in Africa, South and Central America, can be treated using Mebendazole. It is not recommended to treat this as part of a cleanse, unless there are risk factors from travel or a confirmed infection.

   1. Mebendazole 100 mg BID for 14-21 days

5. Fasciola hepatica is treatable by triclabendazole. It is not recommended to treat this as part of a cleanse, unless there are risk factors from travel or a confirmed infection.

   1. Triclabendazole 10mg/kg x 2 doses

Combining the findings from Anti-Protozoan and Anti-Helminthic Therapies

Now that we have determined which drugs can target the most protozoans and helminths, let’s combine the findings.

Drug Interactions

Checking for any drug interactions reveals the following.

The following should be noted:

1. Metronidazole should never be taken with alcohol

2. Mebendazole and Triclabendazole have certain serious adverse events, if taken along with metronidazole.

3. Albendazole and Praziquantel should be taken with food. Fatty food allows albendazole to cross blood-brain barrier to address neurologic symptoms, and infection.

4. If treating malaria (plasmodium) with Chloroquine, pay attention not to combine with metronidazole and praziquantel. And there is a serious adverse event associated with triclabendazole used for fasciola, so don’t treat malaria and fasciola at the same time.

5. If treating toxoplasmosis with pyrimethamine and sulfadizine, there is increased risk of anemia, and Leucovorin has to be added

Final recommendations for a Cleanse

The final recommendations for a cleanse eliminates parasites that are either treated with IV administered drugs (i.e. Amphotericin) or parasites that don’t need to be treated without a confirmation of infection (i.e. malaria, toxoplasmosis, mansonella perstans). See below the drug regimen that would yield the greatest efficacy, and most coverage of parasites. All drugs are drug of choice and approved for human use.

Final recommendation has 5 drugs and 3 supplements in total. The 5 drugs are Metronidazole (3 protozoa parasites), Albendazole (18 parasites), Praziquantel (11 parasites), Ivermectin (4 parasites), and Triclabendazole (1 parasite), for a total of 37 parasites addressed. The 3 supplements are Iron, B12, and Folic Acid.

Natural Treatments of Parasites

As stated before, natural treatments are best for post-cleanse maintenance. While the natural treatments are capable of eliminating adult worms and their eggs and larvae, they are not high in efficacy when there is an active infection. But they are highly effective in preventing an infection in the first place.

Let’s talk about treatment first. The table below shows naturally-derived compound, the source, and the effect on parasites, along with references to the studies. Berberine (in golden seal), a combination of berberine/cucurbitine/palmatine (in pumpkin seeds), papaya seeds, wormwood, propolis from bees, and specific probiotic strains have all been shown to directly treat parasitic infections, reduce worm and egg count, and offer protection against infection in the future.

There are many other natural herbs, foods, and spices that offer some degree of parasitic protection. These include:

• Garlic, neem, turmeric, cloves, coconut, green papaya, black walnut, oregano oil, grapefruit seed extract, and barberry

Finally, Ayurvedic herbs used for parasitic infections include:

• Bilva (Aegle marmelos)

• Haridra (Curcuma longa)

• Krishna jiraka (Centratherum anthelminticum) seeds

• Nimba leaves (Azadirachta indica)

• Vacha (Acrous calamus)

• Giloy (Tinospora cordifolia)

• Vidanga (Embelia ribes)

• Karanj (Pongamia glabra) Seed

• Palash (Butea monosperma) Seed

• Sohanjna (Moringa oleifera) Fruit

• Kutaja (Holarrhena antidysenterica) Stem Bark

• Ajowan (Carum copticum) Seeds

• Mulethi (liqorice)

• Daruharidra (Berberis aristata)

• Kutaja (Holarrhena antidysenterica)

• Mustak (Cyperus rotundus)

• Kutki (Picroorhiza kurroa)

Not all maybe available in the US. Only pre-made Ayurvedic parasite cleanse is found here: https://satveda.com/para-cleaner-capsules/

As mentioned in the beginning of the article, 3 minerals to supplement are selenium, zinc and iron. And 3 vitamins to supplement are Vitamins A, C and B vitamins (B12 & Folic acid).

Can you combine the medical treatments and natural supplements?

Yes, you can. Just don’t take them at the same time. See the slide below that combines some of the natural treatments during the phases of the medical treatment.

• Propolis (bee) extract is best used for it’s protozoan activity, in the first 14 days when you are doing the metronidazole treatment.

• Thereafter, start the supplementation with papaya seeds, pumpkin seeds, wormwood and black walnut as well as the probiotics, and continue this protocol for up to 90 days from start (even after the medical treatment ends). Probiotics will replenish the ‘good’ bacteria. While the supplements will continue creating an environment where the eggs, larvae and adult worms cannot survive, and do not return.

Energetic frequencies for parasite cleanse

You’ve heard the saying that “everything is frequency”. John Garvey of Energetic Medicine Clinic published RIFE frequencies. RIFE machines generate low energetic waves (radiofrequency electromagnetic fields). RIFE frequencies have shown to slow tumor growth. The frequencies published for parasites, are assembled in the table below. You may find a RIFE therapy center near you to support your cleanse, but I don’t recommend this as the only solution/therapy for a full cleanse.

Testing for Parasites

Most of the commercial tests from Quest and Labcorp focus on a few parasites that are common in the US. I’m listing below some comprehensive tests, that give a lot more information to make the best decision.

Please see comparison of 3 comprehensive Parasite tests available.

• Genova Diagnostics Comprehensive Gut Profile Test

• Parasitology Center’s Full GI Panel Test

• Diagnostic Solutions GI-Map Test

Comparison of the 3 tests is provided in the tables below.

Genova Diagnostics - First Choice

Comprehensive Gut Profile Test

https://www.rupahealth.com/lab-tests/genova-gi-effects-comprehensive-profile-3-day

Parasitology Test Only based on parasitic biomarkers

https://www.rupahealth.com/lab-tests/doctors-data-parasitology-3-day#biomarkers

Compared to Parasitology Center’s GI Panel Test, you would miss Mansonella species, and Trichostrongylus species, but GAIN Cystoisospora, Trichomonads, Entamoeba polecki, Capillaria philippinensis, and Opisthorchis.

Compared to Diagnostic Solutions’ GI-MAP Test, you would only gain Pentatrichomonas hominis test.

Sample Report

https://www.gdx.net/core/sample-reports/gi-effects-2200-sample-report.pdf

Parasitology Center Inc.- Second Choice

Full GI Panel Test

https://parasitetesting.com/Full_GI_Panel

Compared to Genova’s Comprehensive Gut Profile Test, you would only gain Mansonella and Trichostrongylus testing.

Compared to Diagnostic Solutions’ GI-MAP Test, you would only gain Pentatrichomonas hominis test.

Sample Report

https://parasitetesting.com/sample%20reports/patient/Full%20GI%20Panel%20Sample%20Report.pdf

Diagnostic Solutions - Last Choice

GI-Map Test

Protozoa: Cryptosporidium, Entamoeba histolytica, Giardia, Blastocystis hominis, Chilomastix mesnili, Cyclospora spp., Dientamoeba fragilis, Endolimax nana, Entamoeba coli, Pentatrichomonas hominis

Worms: Ancylostoma duodenale, Ascaris lumbricoides, Necator americanus, Trichuris trichiura, Taenia spp.

https://www.diagnosticsolutionslab.com/tests/gi-map

Sample Report

https://www.diagnosticsolutionslab.com/sites/default/files/GI-MAP-Sample-Report.pdf

Please note that all 3 tests provide additional information, beyond parasite testing that maybe also useful. Please check the sample reports and order accordingly.