Natural health practitioners and social media influencers continue to talk about “detoxing” or “cleanses” which can include fasting, drinking teas and tinctures, taking supplements, going on special diets, or taking specialized “treatments” (e.g. enemas, foot detox, and nasal irrigation). One cleanse that continues to go viral on social media (and about which we receive countless messages) is the parasite cleanse. The benefits of parasite cleanses sound too good to be true – and that’s because they are. We are going to break this down below.
The concept of a "parasite cleanse" plays on our fears of hidden invaders like unseen worms and “toxins.” It's important to understand and acknowledge that people drawn to parasite cleanses are often motivated by a genuine desire to improve their health– especially if they have been experiencing chronic stomach issues, brain fog, fatigue, and other non-specific issues that linger and cannot seem to be diagnosed by their doctor. They want to take control of their well-being and are bombarded with messages claiming that our bodies are riddled with harmful parasites in many channels both online and in the media. These cleanses are presented as a seemingly simple and natural solution, making them even more appealing to those looking for ways to feel better.
Below, we break down why "cleansing" is not only unnecessary but potentially dangerous, and explore why these trends gain so much traction. We also hope to give you the tools needed to be able to make an informed decision about your health.
What are parasites and who is at risk?
Parasites are an organism that lives on or in a host organism and gets its food from or at the expense of its host. Three main classes of parasites can cause disease in humans: protozoa, helminths, and ectoparasites (for more information from the CDC on each type of parasite).
Parasites are not nearly as prevalent as influencers who sell parasite cleanses might have you believe. While some parasitic infections are common in certain parts of the world, particularly in areas with poor sanitation and the tropics and subtropics, they are relatively uncommon in developed countries with access to clean water and food safety standards. In the United States, the Centers for Disease Control and Prevention (CDC) identifies only a handful of parasitic infections of major concern in the US.
Chagas (trypanosoma cruzi) is found most in Mexico, Central, and South America it’s commonly spread through contact with feces (poop) of an infected triatomine bug (or “kissing bug”). This blood-sucking insect feeds on humans and animals and is found in rural places with poor housing conditions. Chagas can also be transmitted from mother to baby in pregnancy, from contaminated blood or organ transplants, or other rare routes like in a lab or contaminated food.
Cyclosporiasis (Cyclospora cayetanensis) is found mostly in tropical and subtropical regions and has been introduced by imported fresh produce into the US. Infections result from ingesting the sporulated oocysts (eggs) in food or water which are infective. It takes 1 - 2 weeks to sporulate and be infective and manifests as an infection in the small intestine that results in watery diarrhea, nausea, fatigue, cramping, bloating, loss of appetite and sometimes vomiting or fever.
Toxocariasis or roundworms (Toxocara canis from dogs and, less commonly, Toxocara cati from cats) - found in the US, particularly in those who own dogs or cats or those exposed to dirt with feces of an infected animal. Most people infected show no symptoms, but the larva can spread to various organs (e.g. liver, lungs, central nervous system, eyes) and then exhibit symptoms such as a fever, cough, enlarged liver, or inflammation and scarring of the retina in the eye (ocular toxocariasis). The CDC is targeting this infection for public health action.
Cysticercosis (Taenia solium) is a parasitic tissue infection caused by larval cysts of the tapeworm. The highest rates of infection are found in areas of Latin America, Asia, and Africa that have poor sanitation and free-ranging pigs. Although uncommon, it can occur in people who have never traveled outside of the United States, particularly in undercooked infected pork.
Toxoplasmosis (Toxoplasma gondii) is considered to be a leading cause of death attributed to foodborne illness in the United States. More than 40 million men, women, and children in the U.S. carry the Toxoplasma parasite, but very few have symptoms because the immune system usually keeps the parasite from causing illness. Toxoplasmosis can come from various food sources and as well from cats, soil, water, and rarely organ transplants. Pregnant women especially must be vigilant for this infection as it can cause harm to the baby.
Tricomoniasis (Trichomonas vaginalis) is a sexually transmitted disease infecting over 2.6 million men and women in the United States with a prevalence of 2.1% among women ages 14-59, and 0.5% among men. This infection is often asymptomatic, but women are more likely than men to exhibit symptoms. It is treatable but can be avoided by practicing safe sex or abstaining from sexual activity.
Malaria (Anopheles quadrimaculatus) - is transmitted via mosquito bites and has symptoms such as fever, chills, headache, etc, and is extremely rare to catch in the US. (There have been only a handful of endogenous malaria cases in the US). This infection has occurred largely in people who have traveled abroad
For an exhaustive list of all parasites that are tracked by the CDC please feel free to review their site on Parasites.
Can a cleanse work for parasites?
Some of the above infections are not going to be cured by a parasite cleanse simply because of the mode of transmission (e.g. tricomoniasis). The data on cleanses in treating a parasite infection has not been established with robust clinical data. If a clinician has done the appropriate testing (e.g. stool samples, blood testing, endo-/colonoscopy, and sometimes MRI or other advanced imaging) and diagnosed a true parasite infection, there are several antiparasitic treatments that have undergone robust randomized clinical trials and have a significant amount of long-term efficacy and safety data that continue to be monitored via the adverse event monitoring systems in the US and internationally.
Influencers often exaggerate the threat of parasites to create a sense of fear and urgency, leading people to believe they need drastic "cleansing" measures. Many parasite cleanses rely on the idea that a wide range of symptoms (brain fog, fatigue, bloating, etc.) are caused by hidden parasites.
In reality, these common symptoms have many potential causes. True parasitic infections are far less widespread than cleanse proponents claim.
Parasitic diseases make up a small fraction of infectious diseases seen in the US
Infectious disease and parasitic death rates in the US are extremely low (below 50/100000 people)
Among infectious causes of hospital visits in 2019, STDs and Salmonella
were among the highest reported causes of visits
The leading causes of hospitalization in the US are septicemia (bacterial, not parasitic), heart failure, osteoarthritis, pneumonia, and diabetes mellitus
And here’s a resource (pre-COVID) for medical office visits – parasites are not on this list
The term ‘parasite’ encompasses a very wide range of organisms that are not at all similar and have different ways of infecting humans, varying symptoms, differing treatments, and vastly different outcomes. Saying that a cleansing program is treating a “parasite” is disingenuous as you cannot possibly treat all these different types of organisms at the same time and with the same intervention.
The various parasites that are present in humans occur in different places in the body (and can affect different organs), have different life cycles, and curative treatments vary greatly as they must target different proteins present in specific life-cycle stages. A ‘cleanse’ that essentially makes you pass a lot of stool for example is not going to get rid of common parasites that can be present in skeletal muscle, liver, lungs, the myocardium (heart muscle), the eyes, and/or brain.
Parasitic worms are a broad category of parasites that can be transmitted through mosquitoes, food, or soil as discussed earlier. Even with an increase in one type of parasite (hookworms) through the degradation of sewer systems in focused areas in the South, the overall rate of infection is still quite low (unless you happen to live in those areas). There is monitoring of the many infections that can occur as a result of parasites and the CDC and many other global organizations are monitoring prevalence rates, providing public health guidance to reduce or eliminate possible infections, and education for healthcare professionals and patients are ever evolving.
Parasites can cause symptoms that feel like any other intestinal infection, thus making their diagnosis more complicated as food poisoning or other commonly diagnosed gastrointestinal conditions (which are often also challenging to diagnose) will need to be excluded. However, parasites, unlike bacteria, are finely tuned to live in your body undetected and the majority of individuals do not have any symptoms at all. Only about 10% of individuals experience severe symptoms and others may have only mild discomfort. So, if you’re experiencing acute intestinal distress, it may likely not be a parasite, which is why it is important to check with your medical provider if you have concerns.
Toxoplasma gondii is probably one of the more prevalent parasitic infections in the US (as mentioned above). It can be transmitted through eating infected meat or from contact with cat feces. Most people don’t know they have it and then the symptoms clear. This is why antibody tests are problematic for diagnosing parasite infection. People will carry positive IgG antibodies to most parasite infections for a very long time. Usually, an IgG4 test is needed to diagnose acute infection for those parasites that are not present in stool. Treatment is not indicated unless you are pregnant or have a weakened immune system.
Why are cleanses not indicated as part of a routine health routine - can it hurt?
Parasite cleanses are initiated without proper diagnostic testing - stool samples, blood testing, gastroscopy, and other imaging - to confirm the presence of parasites.
This is especially problematic as there are so many different types of parasites, that even syndromic diagnosis* is not possible for parasitic infections. Blood smears are done for malaria, stool samples are taken for intestinal parasites (and this is important because the treatment regimes vary based on what intestinal parasite you have), and toxoplasma is diagnosed by serology. As with Lyme disease, having a physician who specializes in infectious diseases is key because often a positive IgG is not indicative of an active infection, just that the person has been exposed at some point in time.
Science Term Breakdown!
*Syndromic testing combines tests for the most common pathogens capable of causing a specific syndrome into one panel, which can reduce the time needed to provide a diagnosis.
Traditional Diagnosis:
Focuses on identifying the specific disease-causing agent (virus, bacteria, etc.)
Requires separate tests for each potential pathogen
Can be time-consuming and expensive
Syndromic Diagnosis:
Focuses on a set of signs and symptoms that are common to multiple possible illnesses (e.g., respiratory syndrome, gastrointestinal syndrome).
Uses a single test to detect a range of pathogens that could be causing the syndrome.
Provides faster results, allowing for quicker treatment decisions.
“But I have seen the videos on TikTok— people are pooping out worms!” Nope! It is HIGHLY unlikely that these “cleanses” are deworming you, though they will make you poop (a lot) since they act as laxatives. People who have tried these cleanses say that they’ve seen with their own eyes the worms in their poop—so, is it working? Unlikely. What they’re probably seeing is undigested or partially digested food, or mucus threads. Not parasitic worms. Most of the parasites that humans can be infected with wouldn’t look like worms when excreted in our poop.
Proper diagnosis is crucial because all parasites are NOT treated the same way. For example, if you did indeed live in rural Alabama and were unfortunate enough to get a hookworm infection, a ‘cleanse’ would not get rid of it since hookworms latch onto the intestinal lining to feed. This is the same for tapeworms, they are attached to the small intestine and a simple “cleanse” isn’t enough mechanical force to dislodge them.
What are some common ingredients in parasite cleanses?
Herbal and other miscellaneous supplements touted in cleanses may have some antimicrobial properties, but are not targeted, robustly clinically proven effective nor safe, nor regulated properly to confirm their safety.
It is highly unlikely that herbal supplements contain enough of an active ingredient to have any effect. (The dose makes the poison, but it also makes the benefit!) One example is the apocryphal tales of “drinking gin and tonics” to combat malaria because tonic has quinine - but it’s not nearly enough quinine. The drug was isolated and concentrated into a drug form so that it had enough potency to prevent and treat malarial infection.
Claims: Cleanses often claim to "detoxify" or "flush out" parasites, but these are vague, unscientific terms.
One of the biggest misconceptions about “cleanses” is where they act. Usually, they are flushing out the colon, the end of your digestive tract. They do not influence your small intestine or other affected organs, which is where the parasites reside. So ultimately you could be getting rid of beneficial bacteria or altering significantly your hydration levels - all regulated in your colon and not touching the parasite at all.
Any form of laxative acts on the colon and not on the small intestine. This can be dangerous if the laxative effect is excessive as much-needed electrolytes and water absorption can be drastically altered and lead to other dangerous conditions (e.g. seizures, syncope (loss of consciousness), low blood pressure, etc).
Some extraction methods involve pulling “parasites” out of the bottom of your feet. This is mechanistically likely proposed as a solution as some parasites can enter the body via the feet, but many parasites do not remain or reside there. Therefore, in the situation where there are visible parasites, you may extract some, but further systemic infection will not be impacted by foot soaks/treatments if the parasite or eggs have already entered the bloodstream - only local parasitic remnants.
The snake-like gelatinous masses shown in the pictures of cleanses are not fake, but probably just stool or mucous threads (or, in severe cases, maybe colonic lining). This is not a condition we want to necessarily induce in our gut especially if there appears to be blood especially as this means that a more serious condition exists.
Claims that you’re cleansing things that adhere to the intestinal wall are false as well as stool does not adhere to the walls, it compacts into firm masses in the open interior of the colon and can also settle into other organs in the body that are not connected in any way to the gut.
Potential Harm: These cleanses often contain harsh laxatives, herbs, and other ingredients that can disrupt your digestive system. Potential side effects include nausea, vomiting, dehydration, and abdominal pain. In severe cases, they can lead to electrolyte imbalances and even kidney damage. Additionally, these cleanses may interfere with the absorption of essential nutrients and medications, especially with prolonged use.
Electrolyte imbalance is a common side effect of prolonged or overuse of cleanses
You can also permanently or temporarily impair the regular working of your intestines
So what is the take-home message?
Our gut has a delicate balance of bacteria, and other microflora crucial for health. Cleanses can indiscriminately harm beneficial bacteria and other microflora leading to further health issues.
There are no reputable studies demonstrating the effectiveness and safety of parasite cleanses. It is better to get the necessary testing with a qualified healthcare professional to diagnose whether you have a parasite infection and if you need to receive (if appropriate) treatment that has undergone more rigorous clinical studies for efficacy and safety.
Testimonials and anecdotal evidence are not reliable substitutes for rigorous scientific research. Some methods like foot soaks and diets encouraging a better, more balanced nutrient composition, reduced sugar, and increased fiber intake may not be particularly harmful but are not curative if you do have an infection and may not be necessary for the majority of the population.
If someone has a true underlying health issue, a parasite cleanse might mask symptoms and delay them from getting a proper medical diagnosis and curative treatment. Please consult a trusted healthcare professional if you have questions or concerns.
Contributor:
Alexis Katsis, MS (Public Health Microbiology), PhD (Microbiology and Immunology). You can find her as the host of the LuxeSci podcast!
Special thanks to Michelle Bridenbaker for lending her expertise in medical toxicology and clinical medicine and co-authoring this piece.