You've tried all sorts of things, like changing your diet, different supplements, and maybe you've been given a diagnosis of irritable bowel syndrome.
And despite everything you do, the symptoms remain. Your gut never really settles, and your stools keep changing. Sometimes the consistency is fine, then you're back to sudden urgency and diarrhoea.
In some of the people we see in our practice, an underlying gut parasite turns out to be behind these symptoms. Often it's Dientamoeba fragilis, one of the most common gut parasites. And it's exactly the one that standard testing often misses.
What exactly is Dientamoeba fragilis?
Despite its name, Dientamoeba fragilis isn't an amoeba but a flagellate: a single-celled parasite that lives in your large intestine. It's so small you'll never see it yourself; only targeted laboratory testing can detect it. It's estimated that more than a third of people with chronic gut symptoms carry it, which makes it one of the most common harmful gut parasites.
What makes it tricky is that it has no cyst form. Many other parasites, like Blastocystis hominis, spread through such a hardy survival form, but with Dientamoeba fragilis it works differently. Infection probably happens through contaminated water or food, or through contact with the stool of someone who carries the parasite.
Symptoms of Dientamoeba fragilis
What makes it so hard is that the symptoms closely resemble those of other gut problems, so it's difficult to put your finger on it. You might notice loose or mushy stools, mucus in your stool, abdominal cramps, a bloated belly, less appetite, or a tiredness that just won't lift. Sometimes you struggle to keep weight on, lose weight without meaning to, or develop anaemia.
If you pay attention, a pattern often becomes visible: good days alternate with days when your gut runs your whole day. That's because parasites grow in a cycle. When the cycle matures, your body is affected in a way that gives you strong urgency with mushy stools, which pushes the parasites out of your body. At that moment a new cycle begins.
You can track this by making a note on your phone, or in a little notebook in the bathroom, every time it happens. Over time you may see a repeating pattern of symptoms that comes back every few days. Keep in mind that when several cycles are active, the symptoms will occur more often too. It's not watertight, but it can give you a good indication.
A possible cause
Whether you've had no explanation for your symptoms yet, or a diagnosis such as irritable bowel syndrome, Crohn's disease or ulcerative colitis, a parasite can play a part in all of these. For many people the link is never made between their symptoms and the presence of a parasite in the gut, simply because no one ever looked for it.
Why one person gets symptoms and another doesn't
A parasite can only take over if your gut gives it room. Your gut microbiome, the community of millions of bacteria that live in your large intestine, normally keeps intruders in check. When that balance is disturbed, for example by a course of antibiotics, long-term stress or a one-sided diet, a parasite like Dientamoeba fragilis gets a far better chance to dominate and cause symptoms.
You can picture it as a game of musical chairs. As long as all the chairs are taken by gut-flora bacteria, the parasite can't sit down. But the moment one is empty, it can. And the parasite.. it settles in comfortably, and like a bully it shoves the others off their chairs so it can take more space and multiply.
It rarely comes alone, either. In some people with Dientamoeba fragilis we also find Blastocystis hominis, another parasite that can cause similar symptoms. When the gut flora is disturbed and parasites are present, digestion suffers, so you absorb fewer nutrients from your food, your energy drops and all sorts of physical symptoms can arise. It also means your immune system has to defend your body constantly, which takes a lot of energy and makes you more prone to developing food intolerances and inflammation.
There are conventional medicines your doctor can prescribe to treat the parasite. This is usually a course of antibiotics, which turns out to be effective against the parasite in about half of cases.
The downside of antibiotics is that they aren't selective. While they fight off the parasite, they also disturb your gut flora further. And it's that disturbed gut flora that can make you more prone to new gut problems, or to a worsening of the symptoms you already have.
So to truly recover, clearing the parasite alone is often not enough. The way your digestion works and the make-up of your gut flora also need to come back into balance. If that underlying balance stays disturbed, it leaves the door open to new problems.
How to detect a gut parasite
In our practice, a parasite often turns out to be the missing piece in cases no one could explain.
You can detect a parasite with a stool test. The most reliable method these days is the qPCR test, where the laboratory looks for the parasite's DNA. That method is a good deal more accurate than the older Triple Feces Test, which is now outdated.
A good stool test looks further than Dientamoeba fragilis alone. That's why we examine more than 80 markers in the stool. We look at the make-up of your gut flora, whether the beneficial bacteria are present in the right amounts, and whether there's any bacterial overgrowth, yeast such as Candida, or parasites like Blastocystis hominis and Giardia lamblia. That way you know not only whether there's a parasite, but also how your gut flora is doing as a whole.
Maybe this is exactly the missing piece in your search: not another diet or supplement, but understanding what's going on in your gut and what's really causing your symptoms.