How worried should I be about cryptosporidiosis? Am I safe at the pool?

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You might have heard of something called “cryptosporidiosis” recently, closely followed by warnings to stay away from your local swimming pool if you’ve had diarrhoea.

More than 700 cases of this gastrointestinal disease were reported in Queensland in January, which is 13 times more than in January last year. Just under 500 cases have been recorded in New South Wales this year to-date, while other states have similarly reported an increase in the number of cryptosporidiosis infections in recent months.

Cryptosporidiosis has been listed as a national notifiable disease in Australia since 2001.
But what exactly is it, and should we be worried?

What causes cryptosporidiosis, and who is affected?

Cryptosporidiosis is the disease caused by the parasite Cryptosporidium, of which there are two types that can make us sick. Cryptosporidum hominis only affects humans and is the major cause of recent outbreaks in Australia, while Cryptosporidium parvum can also affect animals.

The infection is spread by spores called oocysts in the stools of humans and animals. When ingested, these oocysts migrate and mature in the small bowel. They damage the small bowel lining and can lead to diarrhoea, nausea, vomiting, fever and abdominal discomfort.

Most people develop symptoms anywhere from one to 12 days after becoming infected. Usually these symptoms resolve within two weeks, but the illness may last longer and can be severe in those with a weakened immune system.

Children and the elderly tend to be the most commonly affected. Cryptosporidiosis is more prevalent in young children, particularly those under five, but the disease can affect people of any age.

A 'pool closed' sign in front of a swimming pool.
A number of public pools have been closed lately due to cryptosporidiosis outbreaks.
LBeddoe/Shutterstock

So how do we catch it?

Most major outbreaks of cryptosporidiosis have been due to people drinking contaminated water. The largest recorded outbreak occurred in Milwaukee in 1993 where 403,000 people were believed to have been infected.

Cryptosporidium oocysts are very small in size and in Milwaukee they passed through the filtration system of one of the water treatment plants undetected, infecting the city’s water supply. As few as ten oocysts can cause infection, making it possible for contaminated drinking water to affect a very large number of people.

Four days after infection a person with cryptosporidiosis can shed up to ten billion oocysts into their stool a day, with the shedding persisting for about two weeks. This is why one infected person in a swimming pool can infect the entire pool in a single visit.

Cryptosporidium oocysts excreted in the faeces of infected humans and animals can also reach natural bodies of water such as beaches, rivers and lakes directly through sewer pipes or indirectly such as in manure transported with surface runoff after heavy rain.

One study which modelled Cryptosporidium concentrations in rivers around the world estimated there are anywhere from 100 to one million oocysts in a litre of river water.

In Australia, cryptosporidiosis outbreaks tend to occur during the late spring and early summer periods when there’s an increase in recreational water activities such as swimming in natural water holes, water catchments and public pools. We don’t know exactly why cases have seen such a surge this summer compared to other years, but we know Cryptosporidium is very infectious.

Oocysts have been found in foods such as fresh vegetables and seafood but these are not common sources of infection in Australia.

What about chlorine?

Contrary to popular belief, chlorine doesn’t kill off all infectious microbes in a swimming pool. Cryptosporidium oocysts are hardy, thick-walled and resistant to chlorine and acid. They are not destroyed by chlorine at the normal concentrations found in swimming pools.

We also know oocysts can be significantly protected from the effects of chlorine in swimming pools by faecal material, so the presence of even small amounts of faecal matter contaminated with Cryptosporidium in a swimming pool would necessitate closure and a thorough decontamination.

Young children and in particular children in nappies are known to increase the potential for disease transmission in recreational water. Proper nappy changing, frequent bathroom breaks and showering before swimming to remove faecal residue are helpful ways to reduce the risk.

Two children playing in a body of water.
Cryptosporidium can spread in other bodies of water, not just swimming pools.
Yulia Simonova/Shutterstock

Some sensible precautions

Other measures you can take to reduce yours and others’ risk of cryptosporidiosis include:

  • avoid swimming in natural waters such as rivers and creeks during and for at least three days after heavy rain
  • avoid swimming in beaches for at least one day after heavy rain
  • avoid drinking untreated water such as water from rivers or springs. If you need to drink untreated water, boiling it first will kill the Cryptosporidium
  • avoid swallowing water when swimming if you can
  • if you’ve had diarrhoea, avoid swimming for at least two weeks after it has resolved
  • avoid sharing towels or linen for at least two weeks after diarrhoea has resolved
  • avoid sharing, touching or preparing food that other people may eat for at least 48 hours after diarrhoea has resolved
  • wash your hands with soap and water after going to the bathroom or before preparing food (Cryptosporidium is not killed by alcohol gels and sanitisers).

Not all cases of diarrhoea are due to cryptosporidiosis. There are many other causes of infectious gastroenteritis and because the vast majority of the time recovery is uneventful you don’t need to see a doctor unless very unwell. If you do suspect you may have cryptosporidiosis you can ask your doctor to refer you for a stool test.The Conversation

Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Celery vs Lettuce – Which is Healthier?

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    Our Verdict

    When comparing celery to lettuce, we picked the lettuce.

    Why?

    Let us consider the macros first: lettuce has 2x the protein, but of course the numbers are tiny and probably nobody is eating this for the protein. Both of these salad items are roughly comparable in terms of carbs and fiber, being both mostly water with just enough other stuff to hold their shape. Nominally this section is a slight win for lettuce on account of the protein, but in realistic practical terms, it’s a tie.

    In terms of vitamins, celery has more of vitamins B5 and E, while lettuce has more of vitamins A, B1, B2, B3, B6, B7, B9, C, K, and choline. An easy win for lettuce here.

    In the category of minerals, celery has more calcium, copper, and potassium, while lettuce has more iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. So, a fair win for lettuce.

    Adding up the sections makes for an overall win for lettuce; of course, enjoy both, though!

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  • 5 Golden Rules To Lose Belly Fat

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    Our belly is often the first place we gain fat and the last to lose it—due to hormonal changes, poor blood flow, and fat cell types. This also means that weight loss efforts can result in it looking worse before it looks better, as we lose weight from elsewhere around it. But, there is a way forwards:

    What to do about it

    Cori Lefkowith, of “Redefining Strength” and “Strength At Any Age” fame, advise that we follow the following “5 golden rules”:

    1. Mindset: avoid “All or Nothing” thinking; focus on small, sustainable changes and consistent habits.
    2. Macros: prioritize protein (40%+ of calories), balance fats and carbs for hormonal health, and avoid extreme calorie deficits (your body will try to save you from starvation by slowing your metabolism to conserve energy, and storing fat).
    3. Nutrition quality: focus on whole, nutrient-dense foods for better satiety, gut health, and energy. Get plenty of fiber and water; your body still needs those too.
    4. Muscle building: strength training preserves muscle, boosts metabolism, and improves body composition—don’t ditch your strength training for cardio; it won’t help and that swap would hinder..
    5. Daily walks: 15–20 minutes of walking after dinner aids digestion, and reduces stress (remember: stress invites your body to store extra fat, especially at the belly). It also incidentally burns calories without stressing the body, but honestly, it’s really not very many calories, so that’s not the main reason to do it.

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    Visceral Belly Fat & How To Lose It ← this is not the same thing as subcutaneous fat; the remedy is partly the same though, and it’s important to do both if you’re carrying excess weight both on your belly and in your viscera, if you want to reduce your overall waist size.

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  • An Accessible New Development Against Alzheimer’s

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    Dopamine vs Alzheimer’s

    One of the key hallmarks of Alzheimer’s disease is the formation of hardened beta-amyloid plaques around neurons. The beta-amyloid peptides themselves are supposed to be in the brain, but the hardened pieces of them that form the plaques are not.

    While the full nature of the relationship between those plaques and Alzheimer’s disease is not known for sure (there are likely other factors involved, and “the amyloid hypothesis” is at this stage nominally just that, a hypothesis), one thing that has been observed is that increasing or reducing the plaques increases or reduces (respectively) Alzheimer’s symptoms such as memory loss.

    Neprilysin

    There is an enzyme, neprilysin, that can break down those plaques.

    Neprilysin is made naturally in the brain, and/but we cannot take it as a supplement or medication, because it’s too big to pass through the blood-brain barrier.

    A team of researchers led by Dr. Takaomi Saido genetically manipulated mice to produce more neprilysin, and those mice resultantly experienced fewer beta-amyloid plaques and better memory in their old age.

    However wonderful for the mice (and a great proof of principle) the above approach is not useful as a treatment for humans whose genomes weren’t modified at our conception in a lab.

    Since (as mentioned before) we also can’t take it as a medication/supplement, that leaves one remaining option: find a way to make our already-existing brains produce more of it.

    The team’s previous research allowed them to narrow this down to “there is probably a hormone made in the hypothalamus that modulates this”, so they began experimenting with making the mice produce more hormones there.

    The DREADD switch

    DREADDs, or Designer Receptors Exclusively Activated by Designer Drugs, were the next tool in the toolbox. The scientists attached these designer receptors to dopamine-producing neurons in the mice, so that they could be activated by the appropriate designer drugs—basically, allowing for a “make more dopamine” button, without having to literally wire up the brains with electrodes. The “button” gets triggered instead by a chemical trigger, the designer drug. You can read more about them here:

    DREADDs for Neuroscientists: A Primer

    The result was positive; when the mice made more dopamine, the result was that they also made more neprilysin. So far, the hypothesis is that the presence of dopamine upregulates the production of neprilysin. In other words, the increased neprilysin levels were caused by the increased dopamine levels (the alternatives would have been: they were both caused by the same thing—in this case that’d be the DREADD activation—or the increase was caused by something else entirely that hadn’t been controlled for).

    As to how the causal relationship was determined…

    “But I don’t have (or want) a DREADD switch in my head”

    Happily for us (and probably happily for the mice too, because dopamine causes feelings of happiness), the experiments continued.

    This time, instead of using the DREADD system, they tried simply supplementing the mouse food with l-dopa, a dopamine precursor. L-dopa is often used in the treatment of Parkinson’s disease, because the molecules are small enough to pass through the blood-brain barrier, and can be converted to full dopamine inside the brain itself. So, taking l-dopa normally raises dopamine levels.

    The results? The mice who were given l-dopa enjoyed:

    • higher dopamine levels
    • higher neprilysin levels
    • lower beta-amyloid plaque levels
    • better memory in tests

    The next step for the researchers is to investigate how exactly dopamine regulates neprilysin in the brain, but for now, the relationship between l-dopa consumption and the reduction of Alzheimer’s symptoms seems clear.

    You can read about the study here:

    The dopaminergic system promotes neprilysin-mediated degradation of amyloid-β in the brain

    Is there a catch?

    L-dopa has common side effects that are not pleasant; the list begins with nausea and vomiting, and continues with things that one might expect from having “too much of a good thing” when it comes to dopamine, such as dyskinesia (extra movements) and hallucinations.

    You can read about it more here at the Parkinson’s Foundation:

    Parkinson’s Foundation | Levodopa

    However! All is not lost. Rather than reaching for the heavy guns by taking l-dopa unnecessarily, there are other dopamine precursors that don’t have those side effects (and are consequently less restricted, to the point they can be purchased as supplements, or indeed, enjoyed where they occur naturally in some foods).

    Top of the list of such safe* and readily-available dopamine precursors is…

    N-Acetyl L-Tyrosine (NALT): The Dopamine Precursor & More

    If you’d like to try that, here’s an example product on Amazon… Or you could eat fish, white beans, tofu, natto, or pumpkin seeds 😉

    *Quick note on safety: “safe” is a relative term and may vary from person to person. Please speak with your own doctor to be sure, check with your pharmacist in case of any meds interactions, and be especially careful taking anything that increases dopamine levels if you have bipolar disorder or are otherwise prone to psychosis of any kind. For most people, this shouldn’t be an issue as our brains have a built-in mechanism for scrubbing excess dopamine and ensuring we don’t end up with too much, but for some people whose dopamine regulation is not so good in that regard, it can cause problems. So again, speak with your doctor to be sure, because we are not doctors, let alone your doctor.

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    If you’d like an entirely drug-free approach, that’s skipping even the “nutraceuticals”, you might enjoy:

    Short On Dopamine? Science Has The Answer

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    What you need to know

    • Whooping cough is a bacterial respiratory illness that can cause long-term symptoms and even death.
    • Two types of vaccines protect against it: The DTap vaccine is given to babies and children up to 6 years old, while the Tdap vaccine is given to children 7 years and older and adults.
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    What are the symptoms of whooping cough?

    Early symptoms of whooping cough typically appear five to 10 days after exposure and may include a runny or stuffy nose, a low fever, and a mild cough. One to two weeks later, some people may experience extreme coughing fits that can cause shortness of breath, trouble sleeping, vomiting, fatigue, and rib fractures. These fits usually last one to six weeks, but they can last up to 10 weeks after infection. 

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    Two types of vaccines protect against whooping cough: The DTap vaccine is given to babies and children up to 6 years old, while the Tdap vaccine is given to children 7 years and older and adults. Both vaccines protect against infections from diptheria, tetanus, and pertussis.

    The Centers for Disease Control and Prevention recommends that pregnant people receive a single dose of the Tdap vaccine between 27 and 36 weeks of pregnancy, as this lowers the risk of whooping cough in babies younger than 2 months old by 78 percent.

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    What should families do when whooping cough symptoms appear?

    If you or your child has symptoms of whooping cough, isolate the infected person from vulnerable family members. It’s also important to seek treatment early to reduce the risk of serious illness. Health care providers typically prescribe antibiotics to those recovering at home.

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  • What I Wish People Knew About Dementia – by Dr. Wendy Mitchell

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    We hear a lot from doctors who work with dementia patients; sometimes we hear from carers too. In this case, the author spent 20 years working for the NHS, before being diagnosed with young-onset dementia, at the age of 58. Like many health industry workers who got a life-changing diagnosis, she quickly found it wasn’t fun being on the other side of things, and vowed to spend her time researching, and raising awareness about, dementia.

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    Instead, Dr. Mitchell—an honorary doctorate, by the way, awarded for her research—writes about what it’s actually like to be a human with dementia. Everything from her senses, how she eats, the experience of eating in care homes, the process of boiling an egg… To relationships, how care changes them, to the challenges of living alone. And communication, confusion, criticism, the language used by professionals, or how things are misrepresented in popular media. She also talks about the shifting sense of self, and brings it all together with gritty optimism.

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  • How to Vary Breakfast for Digestion?

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    It’s Q&A Day at 10almonds!

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    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

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    ❝Would appreciate your thoughts on how best to promote good digestion. For years, my breakfast has consisted of flaxseeds, sunflower seeds, and almonds – all well ground up – eaten with a generous amount of kefir. This works a treat as far as my digestion is concerned. But I sometimes wonder whether it would be better for my health if I varied or supplemented this breakfast. How might I do this without jeopardising my good digestion?❞

    Sounds like you’re already doing great! Those ingredients are all very nutrient-dense, and grinding them up improves digestion greatly, to the point that you’re getting nutrients your body couldn’t get at otherwise. And the kefir, of course, is a top-tier probiotic.

    Also, you’re getting plenty of protein and healthy fats in with your carbs, which results in the smoothest blood sugar curve.

    As for variety…

    Variety is good in diet, but variety within a theme. Our gut microbiota change according to what we eat, so sudden changes in diet are often met with heavy resistance from our gut.

    • For example, people who take up a 100% plant-based diet overnight often spend the next day in the bathroom, and wonder what happened.
    • Conversely, a long-time vegan who (whether by accident or design) consumes meat or dairy will likely find themself quickly feeling very unwell, because their gut microbiota have no idea what to do with this.

    So, variety yes, but within a theme, and make any changes gradual for the easiest transition.

    All in all, the only obvious suggestion for improvement is to consider adding some berries. These can be fresh, dried, or frozen, and will confer many health benefits (most notably a lot of antioxidant activity).

    Enjoy!

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