> “If my intestines were a warzone, we went full nuclear,” Johnson remarked
Is that giardiasis treatment, or just let's kill everything and hope for the best? Glad it worked out for him.
> “If my intestines were a warzone, we went full nuclear,” Johnson remarked
Is that giardiasis treatment, or just let's kill everything and hope for the best? Glad it worked out for him.
Gluten consumption, on its own, can cause small bowel inflammation and this effect is well known (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677194/)
I don't think restrictive diets are a great idea, because I want to stay healthy otherwise and ultimately restore that balance, but curiously enough, I've found that wheat might be exacerbating some of these symptoms—despite eating it without issue my whole life.
No matter how neutrally and deferentially I approach doctors with this info, I'm treated like a paranoiac for merely inquiring about certain possibilities like so-called SIBO. I'm pretty sure I'd get dragged straight to the loony bin if I ever mentioned parasites.
Sorry for making this about me, but I wrote all this to say: this guy is very lucky he's a medical student. Even with similar evidence, I have a hard time believing he'd get medicine (and respect) as a single mother. The moment she whipped out slides like he did, they'd be writing an antipsychotic Rx.
People in developed countries have very little knowledge of parasitic diseases (ok, maybe only of tick-bourne diseases)
You wouldn't need Dr House to diagnose tape worm in a lot of less developed countries.
This turned out to be lactose so I just avoid it and all is good now. Could have been a new finding but I suspect the problem was just poorly identified to start with.
Totally useless.
A gastroenterologist asked if I had taken anti-biotics at any point. I had: 12 months prior I had gone swimming near a landfill, gotten sick, and my primary care doctor had prescribed antibiotics (suspecting giardia). This final GI doctor asked if I had taken probiotics after my regimen of antibiotics. I had not. He ordered a colonoscopy (I think the prep process for that itself – a hard reset – may have done something therapeutic) and I was prescribed probiotics (viz: over-the-counter refrigerated Natren Megadophilus pills, refrigerated MegaFood MegaFlora pills, and refrigerated Bio-K Plus drinks). After the scope prep, scope, and two weeks of probiotics, I could eat gluten again.
I've shared this story with others but wish I had more evidence so that it might have been written up in a way that helped others like Anders. It was frustrating that none of the many providers I saw during that year tied the giardia incident (in my chart) to gluten intolerance (some instead made mild allusions to psychosomatic IBS) until the final gastroenterologist (my hero! I am forever grateful) but I can't complain. Ever since that difficult year, I have tremendous empathy for those with allergies and intolerances, especially for those with celiac.
I was fortunate that over time I managed to return myself to full capacity, through reading a ton of research and running dozens of experiments like the above. But it was so damn hard. The symptoms reduced my ability to use my brain to fix myself. And if you're not a careful eater, it's not at all intuitive which foods contain gluten. This was also almost a decade ago while living in a developing country, so it wasn't even apparent that gluten might be a suspect.
I'm currently based in the US - does anyone know how one might get properly tested for chronic giardiasis, as a person who isn't themselves in microbiology? I almost certainly encountered poorly treated water in that period of my life.
Also - I can't help but suspect that a nontrivial percentage of the developing world is living below their full capacity due to something like this. Neglected tropical diseases are a horrendous category.
Most of the people a doctor gets either almost can't read or think they have all the diagnosis from "the internet". It's rare to have someone capable, who isn't going to jump to conclusions and just complicate everything, so I get why they discard most of what people tell them.
How about this for an app idea? Does this already exist?
Use the app to record all the food consumed. Use AI to read restaurant menus, cereal boxes, ect. Give the user a survey every 1 hour. Make eating A/B testing strategies, for example, have the user not eat dairy for a day, then not eat gluten, ect.. Do some calculations and figure out what foods cause what symptoms.
WHO literally estimated 1 billion living people were infected with hookworm at some point throughout childhood. Once that happens in areas with poor food security to begin with your brain is likely fucked for life from stunted development due to childhood malnutrition.
Diminished capacity due to disease burden is definitely high.
In my experience the medical system is unusually useless and dismissive with digestive issues. I think this is probably related to how little it can do in this area. 10-15% of the US has IBS, and this is a disease of exclusion. That literally means that the medical system acknowledges a cluster of symptoms, but has no idea what is causing them or how to cure them. I can imagine that blaming patients is easier than the alternatives for some doctors.
Bread is getting a bad name, yet whole civilisations have been founded on it. This bad name is coming along at a time when most of what most people eat is 'processed food' rather than 'real food'.
I brought my own bread making 'in house' with a bread making machine and I have not looked back. Not so much as a slice goes in the bin and the machine is on 2-3 times a week. I have no incentive to pay more for bread laced with preservatives that does not taste quite as good. I have just the four ingredients, well, I add a spot of olive oil too, to keep it soft, but you get the idea. I don't add any extract of human hair into it, or any propionic acid as a preservative. There are no 'processing aids' that don't appear on the ingredients list.
I hear you regarding restrictive diets, however, I did restrict my diet to cut out all of the processed foods and to always cook from scratch. I buy mostly vegetables and fruit. Those aisles of frozen things or things in bright packaging are of no interest to me. I have just chosen the good stuff, and changed my ideas on what that might be.
This was just done on a whim, to see if I could last a whole week without chocolate, sticky toffee puddings, ready made pizza and all those good things. I did not expect to feel so much better in such a short period of time, so I decided to go for a month, which was easy, and, after that, the pattern was set.
I had always considered a certain amount of bloating, poorly formed movements and the rest of it as normal. Oh, how wrong I was! I have not had the slightest problem since my 'nutrition experiment' started and a fully working digestive tract is such a pleasant life upgrade. It is not something one brags about, 'having perfectly working bowels', but there is no way I would go back to eating processed food garbage.
The only downsides are no farts that smell (always odourless is weird), and no time spent doom-scrolling 'on the throne' (visits to the restroom are all too brief to need a book or a phone).
In my opinion we have over-complicated the deal with our microbes. We do this to get to a stage where people avoid fibre at all costs or become fearful of bread. From my n of 1 experience, wonderful things happen if eating just real food, as in mostly vegetables. I don't think there is anything wrong with sugar, all I know is that I can live life without it, and prefer having good teeth. It is the same with fats, clearly some are bad, but, from fairly natural sources, all is fine. Palm oil is ubiquitous in processed foods, and there is nothing wrong with it, but I don't have any in my food and see no reason to seek out processed foods that have it.
I count the half hour I spend in the kitchen as 'physical activity' and ring-fence that time much like how some people go to the gym. I know it is low intensity and not a 'workout', but, once I get off the sofa and into the kitchen, I enjoy preparing vegetables and cooking. I also enjoy the money saved. My 'superfoods' are things like potato and carrot. The only supplements I take are vitamin B12 and vitamin D. I also get to eat more, which is due to calories. Junk food is calorie rich, and, if you are eating mostly vegetables, then you have to eat to satiety, which needs a bit of stomach training.
I don't believe everything can be magically fixed by eating mostly fresh-cooked vegetables. Yeast infections and the like need some prescription medications to resolve, but, once done, there is a new normal of a perfectly working digestive tract, perfect blood pressure, a BMI at the lower end and skin that never gets so much as a pimple.
Give a 'restrictive diet' of just real food a go for a week, make some mistakes along the way, and learn what works for you.
Sigh, it would be useful to know what specific tests for celiac were performed that came back inconclusive or even just stating what doctors consider to be definitive evidence of celiac disease.
However, modern supermarket bread is quite different to what people were eating even 100 years ago. We've selected for wheat with very high gluten levels as it makes for fluffier bread and we've started adding wheat to almost everything as it's cheap. It's very frustrating to go to a shop and see that products that traditionally don't have any wheat in them, now have wheat added to improve shelf life etc. Things like tortillas, onion bhajis, potato fries (or chips as we call them in the UK) etc.
Edit: Had a quick look to see if there's figures for gluten content over time and it looks like I've got the wrong impression from somewhere. This study shows that gluten content has remained relatively static: https://www.sciencedaily.com/releases/2020/08/200811120112.h...
They said that doctors love data. Don't come at them with theories or papers. Give them a food diary + symptoms, it helps a LOT more than "I think I have X".
There's bread and then there is Bread. I can't tolerate "industrial" bread, the kind that stays soft and tender and doesn't get mouldy. It's something to do with the leavening agents they use (yeast or something other).
Basic Scandinavian Rye bread[0] works. Same with the COVID-popularised sourdough. Oat breads are good too.
But if I eat any of the delicious super-soft wheat breads or toasts... Whooo boy, I blow up like a balloon. Don't have celiacs, gluten intolerance or anything like that. For some reason my gut flora can't take some cereals.
There are some anecdotal stories of Americans coming to Europe and suddenly being able to eat bread with no symptoms.
A guy on YouTube will help called Pain Free You. Recent studies suggest bad bacteria can continue to flourish if we are chronically stressed (which symptoms like this easily cause). Huge correlation between stress and flare ups for me.
In the short term whilst you work on the mind-body aspect, I recommend taking Digestive Enzymes with each meal along with a Betain HCL + Pepsin supplement. These are the only supplements that removed my symptoms (and trust me I’ve tried them all). They work by ensuring you have the right level of stomach acid to properly digest food, proteins, carbs and fats so that by the time it hits your digestive tract, there’s less undigested FODMAPs for the bacteria to feed off of.
There IS a light at the end of the tunnel.
Happy to chat about this and what I use since I know this can be hard to go through davzie at davzie dot com.
Like the individual in the OP story, I'm more inclined to suspect a specific undetected infection rather than a lack of dietary discipline. I just don't know how to explore this without having my sanity questioned.
Speaking for myself, I grew up in a home where all our meals were cooked from scratch, no fast food or 'candy', and was horrendously sick growing up due to the amount of (whole wheat, locally baked) bread and dairy in my diet. Had ulcers in my early teens, constant stomach upsets, and lots of secondary related issues.
Certainly eating poorly makes these issues worse, but I didn't grow up in a food desert, or eating an American diet, and they emerged none the less. And at a time (I'm 44) when there was zero awareness of them in the culture.
I was exposed to tonnes of antibiotics as a child - but its hard to deduce cause and effect here. The antibiotics were given because I had frequent gastric distress. Either way, I'm sure my gut bacteria are in a terrible state.
These kind of foods should be home made. Wheat is lesser issue with them.
Even simpler foods like garlic-paste, if bought ready-made in store it contains lot's of unnecessary ingredients.
People buy junk food (pre-made meal) and blame wheat.
> CDC recommends collecting three stool samples from patients over several days for accurate test results. Commercial testing products for diagnosing giardiasis are available in the United States. [1]
Perhaps running three tests is the standard of care, or if not one might advocate for this based on the CDC recommendation. And if dismissed, perhaps there are commercial products available at the consumer level.
[1] https://www.cdc.gov/giardia/hcp/diagnosis-testing/index.html
It is annoying to go out to a fancy restaurant and find that they use wheat based tortillas rather than authentic corn - you'd expect them to be making things themselves rather than just buying them from a shop.
Just thought of another one - Thai-style fishcakes (e.g. in restaurants). Why are they covered in breadcrumbs when Thai food hardly ever uses wheat?
I tried fasting, a few days eating nothing and drinking only water with a bit of salt. It doesn't really work. The bacteria go into hibernation mode until you start eating again.
I don't drink milk anymore and I tried a low FODMAP diet. The latter helped, but I found it so hard to keep up and it was stressful.
I had every diagnostic under the sun. Chest xrays, stool samples, hydrogen methane breath tests (hydrogen positive). I am 99% convinced it was all caused by stress and the antibiotics I took was the straw that broke the camels back.
Stress triggers flight or fight mode. Chronic stress means you're always in this state which means your body isn't producing the digestive enzymes and stomach acid it needs to maintain correct bacteria levels since you don't need to digest food when you're being chased by a metaphorical tiger, better use that energy to run away instead.
The only probiotic I haven't tried that I would like to try is Symprove which is a refrigerated one that was recommended to me by quite a few pharmacists.
Once I am fully confident my stress levels are very low and I've learnt to manage them I will start to wean off the supplements and see if I get a recurrence of symptoms. I'm not yet fully cured but most importantly I'm on the right track.
The idea cereals are bad for health is at least 2 millenia old: https://www.persee.fr/doc/etchi_0755-5857_1983_num_1_1_993
I would describe Anders Johnson (probably a PhD by now) as a responsible and smart young man. It's your body, you must take care of it.
It's true that doctors have to deal with a constant flurry of "I did my own research and think this bruise I got yesterday might be liver cancer", but sometimes people with legitimately debilitating illneses slip through the cracks and have to aggressively advocate for themselves to get any real testing done, particularly if they have a very "let's wait a few months and see what happens" type doctor who never seems to make any progress on their own.
I've been diagnosed with IBS for 10 years but that's hardly any help, I did notice that reducing fat and reducing wheat seems to help with my symptoms. I've tried a lot of different probiotics but they've been no help so far
Sometimes they do, but by definition it's likely not you. It's important to think here that everyone thinks "they are the informed one" or that they are the one that "might have the rare one". Same reason why most people have bought a lottery ticket in their lives or why everyone is of above average intelligence.
I like being active in my medical treatments by doing my own research but I censor a lot of what I say to a doctor, it's usually more to make sure I understand what's going on and that I can double check things.
Even before these, I would try taking just 3g activated charcoal daily for up to a few days, but away from all medicines. It often (but not always) proves quite beneficial for me.
As for ivermectin, it won't hurt to try it, but we haven't established a connection of it to chronic giardisis.
I was taught to suspect worms only in children and immunicompromised adults. And I never found the exception.
On top of that, there are medical schools, not just one. A doctor might be following a [compulsory] guideline from his association / state / institution / college.
In my IBS journey I had a period where I had very strong histamine intolerance, and vitamin C (in the form of QBC vitamin, quercetin + bromelain + vitamin C) really helped stabilize me. Histamine intolerance often led to chronic insomnia, my heart just would not calm down at night.
Celiac is more well known than fodmap issues, and you'd have apparent causality. Eat bread, feel bad. Don't eat bread, feel better.
But not perfect, as many other foods are high fodmap.
Anyway it turns out those with giardisis are sensitive to high fodmap foods so perhaps that could explain it. (Surprisingly also sensitive to low fodmap foods)
I have no idea what is causing this and my doctors have just shrugged. I have no idea where to even start with this.
“Accuracy” is too vague. You want to find out what the sensitivity and specificity are.
https://ebn.bmj.com/content/23/1/2
For instance, a rapid covid test might have low sensitivity but high specificity. Meaning if it’s negative, you could still have the disease. But if it’s positive, you’re almost certainly sick. Ie the false negative rate is a lot higher than the false positive rate.
Anyways, I'm at work now, so hopefully my reply will serve as a nice bookmark to come back to this thread.
I'm tired of my doctors and specialists dismissing all of my attempts at curing myself. They are truly only interested in minimizing symptoms, and NONE of them believe there is a root cause to CURE.
Sadly, situations like these are far more common than people think. My wife studied abroad in India in 2004 and returned with persistent stomach issues. After seeing multiple doctors (gastroenterologists, infectious disease specialists, etc.) and undergoing countless tests (stool samples, endoscopy, colonoscopy), no one could figure out what was wrong. One doctor labeled it IBS (a catch-all diagnosis), and another suggested anti-depressants, citing the side effect of diarrhea to treat her constipation.
Someone recommended she see Dr. Kevin Cahill, who specialized in tropical diseases. He charged $500 in cash and did all the tests himself, including a sigmoidoscopy. Unlike typical practices, he personally examined the samples. After six months of suffering, we got a diagnosis the next day: amoebiasis. With the right medication, she began to improve within weeks.
Dr. Cahill, who passed away in 2022 (https://www.nytimes.com/2022/09/17/nyregion/kevin-m-cahill-d...), had a near-legendary reputation because of his success rate. He was one of the last U.S. doctors to conduct tests and analyze samples himself, a practice that gave him a much higher detection rate for parasitic infections.
Ten years later, we had a similar issue. My wife fell ill again, and despite numerous tests, nothing was found. We went back to Dr. Cahill. Once again, he called the next day with a diagnosis—this time whipworm and giardia. I tested positive too, despite having no symptoms. Dr. Cahill explained that these infections can easily pass between spouses but often don't affect children.
He lamented that modern medicine has drifted away from these hands-on diagnostic practices. In the latest edition of his book, he even published a study showing that major medical institutions only detected parasitic infections in about 50% of known positive samples. The main issue? Sample degradation during transit, disinterested lab technicians, and improper detection methods.
Dr. Cahill was critical of procedures like colonoscopies for detecting protozoa or small helminths. He explained that the bowel-cleansing laxatives used before the procedure wipe out traces of the parasites, leaving the doctor with an inflamed but “clean” view. It’s no surprise that issues return shortly after.
I believe that a significant number of people in developed countries may unknowingly live with parasitic infections, from whipworms to giardia to toxoplasmosis. A single instance of poor hygiene in a restaurant or undercooked food is all it takes. Ironically, poorer countries often have better detection tools due to reliance on old-school methods.
Considering AI's success in areas like breast cancer detection, it seems like there’s a huge untapped potential for AI in diagnosing parasitic infections, especially given the inconsistency and difficulty in manual detection. This is a pervasive issue that cuts across social status, and many infected individuals will never know unless they get lucky with the right doctor.
- A blood test for elevated levels of tTG-IgA antibodies, which are produced by the celiac autoimmune reaction. This has something like a 5% false negative and 10% false positive rate, so it's generally a strong indicator but doesn't totally confirm the diagnosis. - An EGD/biopsy of the small intestine. The lining of the small intestine is damaged by anti-tTG antibodies in a way that's recognizable under a microscope.
Note you can also check your genetic config.log to see if there was a -DALLOW_CELIAC flag in your source build.
Unfortunately your body's settings dialog is shit and does not show you whether or not that feature is set to on or off. But if you were built without that flag then you lack the code for the Celiac algorithm altogether and are good to go. (There may be other sensitivities to gluten, but at least nothing that corrupts your nutrient slurping event loop.)
This distinction might seem pedantic but it's important to be precise when discussing medical issues.
He should have come back negative on that.
My wife and son have Celiac, and I've been tested that way after an incident 15 years ago a lot like the patient in the article.
At the time the doctors were absolutely saying they wouldn't use a negative blood antibody test to determine a negative diagnosis, they wanted the biopsy.
I got tested for Giardia too. My symptoms started after a hiking/biking trip.
If there is any question they should be doing an endoscopy and taking a biopsy of the small intestine. Celiac disease causes the body to destroy villi and they can see that under the microscope.
IIRC, the problem is that gluten is similar to thyroid tissue, and for some people, the immune system will then attack the thyroid as well as causing trouble in the intestines where the gluten was found.
The thread was full of people mentioning that random rashes or other ailments that they assumed were just normal to their bodies for years were cured when they took Ciprofloxacin for a different infection.
22 year military career, avid backpacker, have non-celiac gluten sensitivity since the time I was deployed all over SE Asia.
I think I need to have a conversation with my doc! Thanks a TON for posting this!
Is this even possible? And- only half joking- if it is indeed possible, why isn't there a queue of people waiting to get the parasite installed in their body?
That's sort of how I felt about my student loan. Doctors who didn't take me seriously as a mostly bedridden homemaker went full nuclear and put me on like 8 or 9 prescription drugs when I told one "I took out a student loan for this summer program. I cannot afford to drop out."
As for FODMAP--I've gone that route and gotten a few surprises. The origin of something can matter. The storage can matter.
Does anyone know which grain related agricultural products are used in the USA and not in the EU?
Your pork/ham comment is interesting. For other toxins/allergens/..., I see doctors very explicitly examining every possible extra ingredient/factor before even deigning to consider that the bulk solid might matter (e.g., most chocolate allergies are actually to soy lecithin or one of the other mixins). I'm surprised anyone would rule out a ham problem just because they tested one kind of pork.
Yes, as my GE dismissively smiling told me "we all would like to chug burgers like we did in our youth, wouldn't we?". So talking and describing in details doesn't help much. What helps is if you're on PPO or similar insurance, so the doctor is easy to order tests, whatever you like from like the 20-items list - CAT, genetics, ... . The tests are the key. For SIBO you may get the hydrogen breath test - it is a very simple one - and watch the numbers that the nurse will record from the machine - it will help you understand the situation better. And just like with many other GE issues, getting diagnosed is just half of the journey though. Second is getting it to treat which is again can be a long one (there is a lot of recommendations in this thread - i've tried many of them and they do improve the situation somewhat, nothing though completely solves it for me. I though found some regimen for me which so far made it almost gone. Like many describe - observe and act accordingly.) Btw, just to illustrate the complexity/interdependencies - kind of like in large enterprise software - one of the side effects of SIBO i've got is anemia, discovered accidentally by looking at blood tests results done for something else (again looking into specific numbers yourself seems to be the key as the doctors said nothing) - as SIBO impedes B12 intake, and with B12 and iron supplements i've got my physical abilities back which at the time strangely went down when i started to get tired and running out of breath somewhat quickly for no apparent reason.
Do you know anybody else who does this sort of thing?
https://www.salon.com/2002/08/28/0wnz0red/
(shit, >20 years ago!)
"Giardia lamblia, occasionally called “beaver fever,” is an easily treatable intestinal parasite, unlike celiac disease. If you’ve been backpacking long enough, you probably know someone who’s gotten it. Giardia is normally an acute infection that causes diarrhea, horrendous gas, and other intestinal malaise, but doctors can corral it easily with antibiotics. The chronic form of giardiasis is lesser known, however. The friend sent Johnson medical studies showing how chronic Giardia infection can cause celiac-like symptoms. "
I stopped eating gluten and the associated antigens went down to normal levels. I don't feel any better or worse though.
The literature says there are false positives, and I've always wondered if might be one of them. I've searched celiac forums and I've never encountered anyone with a false positives diagnosis. Lots of false negatives or non-celiac gluten sensitivities though.
I do have the gene required for celiac disease, but most who have this gene do not have celiac disease.
Probiotics didn't help either. Even the refrigerated ones.
Then I started drinking a half cup of unflavoured gelatin before each meal. Take half a tablespoon of the powdered gelatin, mix with half cup water, wait two minutes to dissolve a bit, down the hatch. It's helped like 75% of the way there.
Also, I started taking anxiety meds because my stomach issues get more triggered when I go out and it's early days but that may help.
But it caught up with me. Really badly. And when I say badly, it nearly killed me. I got hypocalcima, and fuck me if it wasn't the most painful thing I ever endured. I've broken bones, etc. All that shit is child's play to every muscle in your body locking up and your body feeling like it is getting stabbed with needles all over. Thankfully once they give you calcium, it goes down. But... I was probably an hour or two away from dead, from asphyxiation.
I played with fire again, and caught it quicker the next time. But I had no concrete diagnosis. Now, I do.
Oh, as a bonus, I got the bones of an 85 year old woman with osteopenia.
Don't fuck with this shit internet stranger. Please.
A digestive research center changed my life. My gluten-induced symptoms (inflammation, joint pain, diarrhea, etc) is linked to something with my gut bacteria. If I take a certain antibiotic that targets the digestive tract, I can eat anything for 9 months including gluten, without problems. After about 9 months, I can no longer eat gluten. And then about a year after that, I can't eat corn. This has repeated 4 times. I always test negative for celiac and sibo. Side note: The doc told me some patients are cured by antiparasitic meds rather than antibiotic.
The doc is now using wellbutrin to change my brain-gut communication and amazingly it cured my corn intolerance and is improving my reaction to gluten, but not yet to the point where I want to eat it. I have 4 more months to go, so this may improve.
Lastly, I know 2 people whose thyroid issues masquerade as gluten intolerance. Consider a "comprehensive thyroid panel"
Hearing this makes me want to keep on track. But I would like regular blood tests to find out if my nutrition absorption is improving. That would at least motivate me to keep eating this restricted diet.
Good to hear your story as a warning.
Because they are liabilities. If he follows along with your theory and you get worse, he doesn't get to claim he was following accepted medical practice.
Plenty of smart guys turn into the doctor's worst enemies after things start going wrong. Wanna know what arguments they use in court against doctors who show patients this sort of respect?
> I couldn't possibly have known
> He is a doctor and I'm just a patient
> My judgement was impaired due to my sickness
If patients want to start dropping theories on doctors, they should be ready to share in the responsibility for the outcome. Courts have demonstrated that the vast majority of people are not ready to accept that responsibility.
> Most of the people a doctor gets either almost can't read or think they have all the diagnosis from "the internet".
Well said. Many of my patients are illiterate. Imagine how hard it is to obtain informed consent. Combine that with internet diagnosis and it's a shit show. I have people asking me about the benefits of some YouTube charlatan's special himalayan salts on a daily basis. And that's when they're not already using those things and dismissing medicine as a corporate conspiracy to keep them sick and perpeptually consuming drugs.
I have no problem with people who googled things, understood those things and who want my professional opinion on the matter. It only becomes a problem for me once they start trying to determine what the treatment is going to be. It's my name, signature and license on the prescription. The only options available to the patient are the ones I'm willing to write on that paper.
Depending on the epidemiology, testing a population is a waste of time and money. They have a very high chance of having the disease and a very high chance of reinfection even after treatment. So what happens is those patients come in every once in a while and they straight up ask for their periodic albendazole dose. And then they go back to their homes and they drink the exact same water and eat the exact same food.
I have no doubt they are, compulsory or not. When things go wrong, the first thing the judge asks is whether the doctor followed established medical practice, whatever that may be.
As a physician with a degree in nutrition, I find most HN threads about medicine, nutrition, or the health system very frustrating, and in spite of it being the only area in which I'm formally qualified to opine, it's also where I've earned most of my downvotes (which prior to 500 internet points kind of mattered). I eventually learned to just bite my tongue here.
Curiously, I think my "hacker spirit" is what drove me to medicine. In undergrad, I was spending 5+ hours per day reading medical literature (mostly nutrition, endocrinology, exercise science) and had decided that doctors were mostly idiots, and eventually decided to change majors from ME to pre-med.
In medical school, I was a real handful to many of the lecturers, which I kind of regret now. Ends up it is really easy to publicly humiliate someone when they mis-state or misunderstand a minor detail that you've studied in depth, even if they have far greater expertise in the field.
In medical school, residency, and practice (EM), I've learned a lot about why things are the way they are. In my field, many patients are entirely obsessed about some problem and completely lose track of reality when discussing it. It becomes part of their identity. They don't know how to read or evaluate medical literature, and they lack the background knowledge to the extent that even beginning a discussion is onerous.
It's like your uncle who is far to one side or the other of the political spectrum and is well read but only in support of his biases -- yes, you might learn something this time, but do you really want to get into long discussion to find out? He already "knows" all the answers to many unstudied questions, and knows why the studies are wrong for the others. There are so many of these patient encounters that it is entirely infeasible to engage with even a small proportion of them and still get your job done, so you learn to nod, smile, and move on to determining whether or not a life-threatening emergency exists or not. You definitely don't have time -- at least in my field -- to really listen and consider all of these. Unfortunately it's not always easy to differentiate symptoms that are possibly psychological, exaggerated, self-limiting, or impractical / impossible to diagnose in my clinical context, from those that present opportunities for me to make a difference even if not a true emergency.
I still think that many doctors are idiots that lack critical thinking skills and self-reflection, and unfortunately almost nobody outside of academics reads primarily literature that isn't forced on them (MOC). I've tried to show many friends and colleagues how to set up RSS feeds for pubmed queries for their topics of interest -- zero people have seemed impressed. In contrast, I think much of HN leans heavily on representativeness heuristic and doesn't consider likelihood ratios when evaluating their test results.
Anyway, thanks for the considerate comment.
Surely you just go to your GP, explain your concerns and symptoms and get tested. Here is the UK NHS page on the subject: https://www.nhs.uk/conditions/giardiasis/
In my research trying to help myself I've come to the conclusion that histamine intolerance is really more of a symptom of a larger issue. It seems to suggest SIBO or any other sort of inflammatory process in the small intestine. Reason being that dysbiosis (of which SIBO is just one sort) has multiple synergizing effects: not only that often the bacteria associated with dysbiosis will produce lots of histamine through fermentation activity (there's a certain klebsiella type I've seen implicated) but also the dysbiosis causes a cascade of issues that degrades the gut lining which increases the amount of dietary histamine that crosses into the body.
Otherwise I've seen histamine intolerance also suggestive of Crohn's, etc. where the gut lining is chronically damaged.
Like you said wine often reveals it for people, also vinegar, aged cheese, meat or seafood. It's funny that now that I know what to look for I notice when eating with people when they get a stuffy nose right after eating that stuff.