WEBVTT - Ep 31 Giardia: Gerardia 0:00:01.680 --> 0:00:02.400 July third. 0:00:03.160 --> 0:00:06.440 I woke that morning lethargic. The coffee didn't help my 0:00:06.559 --> 0:00:09.600 energy materialize, nor did it help clear away the clouds 0:00:09.640 --> 0:00:12.760 that had formed in my brain. My functionability was so 0:00:12.920 --> 0:00:15.080 affected that at one point I was sitting at my 0:00:15.120 --> 0:00:18.079 desk holding my head in my hands. That was the 0:00:18.079 --> 0:00:20.200 moment home seemed like the best place for me to be. 0:00:21.040 --> 0:00:25.759 Something was wrong, something was churning. That was the night 0:00:25.800 --> 0:00:29.160 the sickness hit. It reared its ugly head first by 0:00:29.200 --> 0:00:33.120 the expulsion of the contents of my stomach. I couldn't 0:00:33.120 --> 0:00:36.080 stop it from happening. Try as I may, no deep 0:00:36.120 --> 0:00:39.680 breath would stay the sick I was thwarted at every turn. 0:00:40.200 --> 0:00:42.960 Worship at the throne of the toilet God was inevitable. 0:00:43.680 --> 0:00:47.360 Dehydration became the scariest factor in this situation. I was 0:00:47.400 --> 0:00:50.400 losing more water than I could drink, partly because I 0:00:50.440 --> 0:00:53.360 had no desire to drink. I tried to work, I 0:00:53.440 --> 0:00:56.080 tried to eat. I slept on my sofa, I slept 0:00:56.080 --> 0:00:58.920 in my bed. I didn't get dressed. I barely ate, 0:00:59.560 --> 0:01:03.440 sitting my apartment alone, feeling the rumblings of my bowels, 0:01:03.480 --> 0:01:06.640 knowing that I was getting neither enough water nor nutrients 0:01:06.840 --> 0:01:13.080 was alarming. July eighth, Tuesday, a week since the beginning niagara, 0:01:13.160 --> 0:01:16.560 rushed again. All the happiness and confidence that had been 0:01:16.560 --> 0:01:20.000 present on Monday got flushed right down the toilet. I 0:01:20.080 --> 0:01:22.760 was scared, but I thought I just had to keep waiting. 0:01:24.480 --> 0:01:27.400 July twenty fourth, I sent an email to my doctor's 0:01:27.440 --> 0:01:30.000 office pleading my case, begging for a spot in his 0:01:30.080 --> 0:01:30.880 busy schedule. 0:01:31.520 --> 0:01:32.880 Three weeks after life. 0:01:32.640 --> 0:01:35.800 Took a drastic turn towards Liquidville, I had an appointment 0:01:36.760 --> 0:01:40.520 July twenty sixth Thursday. How was I going to catch 0:01:40.560 --> 0:01:45.280 the evacuating contents of my colon bowl bag? Milk joke, 0:01:46.120 --> 0:01:48.720 milk joke with the top cut off ew. 0:01:48.960 --> 0:01:49.720 A bag it was. 0:01:50.640 --> 0:01:52.920 Having finally figured out how to catch the liquid, I 0:01:53.000 --> 0:01:55.840 was ready now to the fun part. I was back 0:01:55.880 --> 0:01:58.040 on my knees at the throne. Only this time I 0:01:58.120 --> 0:02:00.760 was armed with a spoon small, taller than one. 0:02:00.680 --> 0:02:02.520 Used to feed a child. It's baby food. 0:02:03.000 --> 0:02:05.360 Thankfully, I only had to scoop about a quarter inch 0:02:05.360 --> 0:02:08.440 worth of waiste into each vial with a spoon that small, 0:02:08.480 --> 0:02:13.960 though it took scoop after scoop after scoop. July twenty 0:02:14.040 --> 0:02:17.040 ninth Sunday, I got a call from another doctor who 0:02:17.120 --> 0:02:20.960 works with my doctor. I'd been compromised. Small amounts of 0:02:21.000 --> 0:02:25.480 the parasite Girardia had been found a parasite. I had 0:02:25.560 --> 0:02:29.840 a parasite. After the initial shock, relief again washed over me. 0:02:30.240 --> 0:02:32.760 It was treatable with an antibiotic and I could actually 0:02:32.800 --> 0:02:36.799 start it that day, August fifth, Sunday morning, I took 0:02:36.840 --> 0:02:40.919 the final dose of antibiotic. The party is over. Girardia 0:02:41.080 --> 0:02:44.000 has left the building. As the host of a few 0:02:44.080 --> 0:02:46.560 human parties in my time, this was one of my 0:02:46.680 --> 0:02:50.160 least favorite. A host should have fun at their own party, 0:02:50.639 --> 0:02:54.120 but this party was full of selfish guests. They took 0:02:54.440 --> 0:02:57.440 and took and took from me, giving me nothing in 0:02:57.520 --> 0:03:47.360 return for my accommodations. That's a very you find the 0:03:47.360 --> 0:03:49.119 best first hand accounts, Aaron. 0:03:50.600 --> 0:03:54.920 That one is one of my favorites. I think it's amazing. Hi, 0:03:55.160 --> 0:03:56.840 I'm Aaron Welsh. 0:03:56.360 --> 0:03:58.360 And I'm Erin Almond Updike and. 0:03:58.360 --> 0:04:00.440 This is this podcast will kill you? 0:04:02.040 --> 0:04:03.880 And where did that first hand account come from? 0:04:03.880 --> 0:04:04.160 Aaron? 0:04:04.600 --> 0:04:10.160 So that came from a blog I found. It's Michael 0:04:10.320 --> 0:04:14.119 Roarer dot blogspot dot com, and it's from a August 0:04:14.360 --> 0:04:18.599 twenty twelve entry titled Giardia Ruined My gily Idea, which 0:04:18.640 --> 0:04:20.360 is an amazing title. 0:04:20.400 --> 0:04:21.599 It's a very good title. 0:04:23.560 --> 0:04:26.200 So, as you might have guessed, this week we are 0:04:26.320 --> 0:04:32.000 covering Giardia. Yes, we are the beautiful, beautiful protozoan parasite 0:04:32.000 --> 0:04:35.360 that will cause you to have horrible diarrhea. 0:04:35.440 --> 0:04:38.599 Yes, how fun, wonderful? What enjoy? 0:04:39.240 --> 0:04:43.200 This is kind of back to our standards in terms 0:04:43.200 --> 0:04:44.919 of disease, which I feel like we haven't done for 0:04:44.960 --> 0:04:47.479 a while. So I'm excited to like it's a it's 0:04:47.480 --> 0:04:51.040 a pathogen, and it makes you sick, like our first 0:04:51.080 --> 0:04:53.360 season ones. You know, I feel like we've been doing 0:04:53.360 --> 0:04:56.159 some off the wall crazy episodes lately. 0:04:56.600 --> 0:04:59.040 We did h Pylori, which was along the same lines. 0:04:59.160 --> 0:05:01.880 That's true. Yeah, no, it's hard to keep track. 0:05:01.920 --> 0:05:04.039 We have done a lot of sort of non traditional 0:05:04.080 --> 0:05:05.359 format type ones. 0:05:05.880 --> 0:05:07.160 I'm very excited for this. 0:05:07.880 --> 0:05:10.080 I'm excited to hear all about how it works. I 0:05:10.080 --> 0:05:11.200 don't really know how it works. 0:05:11.240 --> 0:05:12.880 Oh good, I can't wait to tell you. 0:05:13.720 --> 0:05:18.160 To honor Giardia. What are we drinking this week? 0:05:18.720 --> 0:05:22.080 Our quarantine this week is backpackers Delight. 0:05:26.040 --> 0:05:28.479 That's a good that's named because it is a very 0:05:28.520 --> 0:05:32.320 frequent infection in backpackers and many other people as well. 0:05:32.320 --> 0:05:35.919 But backpackers tend to get it from drinking contaminated streams, 0:05:36.160 --> 0:05:39.240 so make sure to filter your water. People. What's in 0:05:39.440 --> 0:05:40.640 backpackers delight. 0:05:40.720 --> 0:05:44.440 In this beverage. We have coconut water, you know, to 0:05:44.520 --> 0:05:48.880 rehydrate you after all that diarrhea, perf pineapple juice because 0:05:49.440 --> 0:05:54.120 it's tasty with coconut water, Ginger liqueur because that's good 0:05:54.120 --> 0:05:59.640 for your stomach, right fans, and vodka. 0:05:59.000 --> 0:06:01.479 Not good for your stomach, not good to rehydrate you, 0:06:01.880 --> 0:06:05.520 but essential for our quarantini. Yes, but our Placy Burrita 0:06:05.600 --> 0:06:08.600 does not contain alcohol, and we will post the recipe 0:06:08.880 --> 0:06:12.239 to both the Quarantini and the alcohol free Plasy Brita 0:06:12.320 --> 0:06:15.080 on our website and on our social media platforms. 0:06:15.400 --> 0:06:17.480 Yes we will. 0:06:17.640 --> 0:06:20.159 So before we start on today's episode, I actually have 0:06:20.240 --> 0:06:23.080 two corrections that I'd like to make that people emailed 0:06:23.160 --> 0:06:28.560 us about so very quickly. One is from I believe 0:06:28.839 --> 0:06:32.799 our last episode or second to last episode on encephalitis, 0:06:33.400 --> 0:06:38.880 so in that this is very embarrassing. Aaron, you mentioned 0:06:39.000 --> 0:06:42.680 that Robert de Niro like won the Academy Award, and 0:06:42.720 --> 0:06:45.640 I was like, oh, I'll fact check you. And I 0:06:45.720 --> 0:06:48.440 did that live during our recording of the episode, and 0:06:48.520 --> 0:06:50.640 I failed at fact checking you. 0:06:51.480 --> 0:06:55.880 I did it incorrectly. Robert de Niro did not win. 0:06:56.160 --> 0:06:59.840 Academy Award for Best Actor for Awakenings, but he was 0:07:00.000 --> 0:07:03.720 dominated he was nominated. Thank you to True Trivia Nerd 0:07:03.800 --> 0:07:05.280 Amelia for writing to. 0:07:05.279 --> 0:07:05.760 Let us know. 0:07:06.360 --> 0:07:08.839 Thanks Amelia, Yeah, keep on the path. 0:07:09.080 --> 0:07:11.040 Oscar Trivia Nerd self proclaimed. 0:07:11.160 --> 0:07:11.760 Okay. 0:07:12.920 --> 0:07:16.360 The other one is from our recent crossover with Indefensive 0:07:16.360 --> 0:07:21.640 Plants where we talked about aspirin. So as I was 0:07:21.680 --> 0:07:25.120 talking about all the various effects of aspirin, one of 0:07:25.160 --> 0:07:28.080 the effects of aspirin is that it's an antipyritic or 0:07:28.120 --> 0:07:31.600 an anti fever, so it reduces fever. Yeah, And in 0:07:31.640 --> 0:07:34.080 the episode I mentioned that this is due to its 0:07:34.120 --> 0:07:36.240 effects on vasodilation. 0:07:37.360 --> 0:07:38.720 I got over excited. 0:07:39.640 --> 0:07:44.920 Vasodilation can produce like local heat production, so like if 0:07:44.960 --> 0:07:47.160 you get a cut and then you have heat, the 0:07:47.200 --> 0:07:51.560 cut feels hot. That kind of heat production can be 0:07:51.640 --> 0:07:57.280 from the vasodilation. But systemically, aspirin is even cooler in 0:07:57.320 --> 0:08:03.040 that prostaglandins in your brain, which aspirin blocks the production 0:08:03.160 --> 0:08:10.000 of modulate the temperature center in your brain. So aspirin 0:08:10.080 --> 0:08:14.240 and other end sets actually work by reducing the temperature 0:08:14.320 --> 0:08:17.920 set point in your brain or blocking the increase in it, 0:08:18.160 --> 0:08:21.040 and that's how they reduce fever. So that's actually a 0:08:21.080 --> 0:08:24.200 much cooler mechanism, and I'm really bummed that I didn't 0:08:24.200 --> 0:08:26.480 mention it in that episode. So thank you very much 0:08:26.480 --> 0:08:28.000 to Kelly for emailing about this. 0:08:28.840 --> 0:08:29.400 Interesting. 0:08:29.760 --> 0:08:32.160 For anyone listening who has no idea what I'm talking about, 0:08:32.320 --> 0:08:34.440 that means you didn't listen to our ASPERN episodes, so you. 0:08:34.400 --> 0:08:40.400 Should go check it out. Hey, Okay, is that all 0:08:40.440 --> 0:08:41.679 the business that we have? 0:08:42.800 --> 0:08:43.000 Yeah? 0:08:43.040 --> 0:08:43.520 I think so. 0:08:44.320 --> 0:08:47.240 Well, then let's take a quick break and then get 0:08:47.240 --> 0:08:48.439 started on the biology. 0:08:49.040 --> 0:09:14.079 Let's do it. Girardia Okay. First of all, there are 0:09:14.120 --> 0:09:16.280 there's only one R in giardia. 0:09:16.920 --> 0:09:27.120 I know, I always call it girardia, butler giardia. Is 0:09:27.200 --> 0:09:27.600 that better? 0:09:28.000 --> 0:09:30.960 Yeah? It's like it's like I think it's the biology 0:09:31.040 --> 0:09:32.520 equivalent of saying nuclear. 0:09:33.040 --> 0:09:35.640 Okay, but I am always afraid that I'm gonna do that, 0:09:35.720 --> 0:09:39.280 so I never say that word in public. Let's say it, 0:09:39.720 --> 0:09:48.440 no girardia, okay, Beaver fever. That's what we're talking about today. 0:09:49.240 --> 0:09:54.880 So gr diasis, which is the disease caused by Girardia. 0:09:57.240 --> 0:10:01.080 Still doing it, Girardia giardia. 0:10:01.520 --> 0:10:06.120 There we go. Listen, it's fine. 0:10:06.360 --> 0:10:10.960 Giardiasis is the most frequently diagnosed intestinal parasite in the 0:10:11.080 --> 0:10:17.680 United States. That's my first fact for you. It's a massive, 0:10:18.040 --> 0:10:22.440 massive disease worldwide. It's common among travelers, it's common across 0:10:22.480 --> 0:10:25.760 the globe. So let's talk about what it is. Yeah, 0:10:26.000 --> 0:10:29.640 first of all, it's a parasite. It's a protozoan, which 0:10:29.640 --> 0:10:32.960 means it's a single celled organism. Protozoin is not a 0:10:32.960 --> 0:10:34.360 great word, but I used it. 0:10:34.440 --> 0:10:34.880 So there. 0:10:36.080 --> 0:10:40.440 It has three different names, three different species names that 0:10:40.480 --> 0:10:42.960 people call it, and it's all the same species, which 0:10:43.000 --> 0:10:44.840 is just to me the most annoying thing. 0:10:45.160 --> 0:10:47.880 Oh my gosh. It made it very difficult to research. 0:10:48.160 --> 0:10:48.360 Yeah. 0:10:48.520 --> 0:10:51.760 It has also changed throughout history multiple times. 0:10:51.800 --> 0:10:53.240 Oh, I'm not surprised about that at all. 0:10:53.679 --> 0:10:54.319 Yeah. 0:10:54.520 --> 0:11:00.360 So in medicine, they're more likely to call it Girardia lamblia. Yeah, 0:11:00.480 --> 0:11:04.679 but in the rest of everything other than like human medicine, 0:11:04.720 --> 0:11:10.679 it's Girardia duodenalis or Girardia intestinalis, which is kind of 0:11:10.720 --> 0:11:14.120 funny because duodenum is just the first part of your intestine, 0:11:14.160 --> 0:11:18.760 so it's kind of like those are interchangeable. But anyways, Girardia, 0:11:21.760 --> 0:11:23.559 I'm only saying one are erin. 0:11:24.400 --> 0:11:28.480 It's never gonna stop. I can't at this point, it's 0:11:28.520 --> 0:11:34.720 too late. It's a flagelet, so that means it has flagella, 0:11:34.760 --> 0:11:37.640 which we've talked about before that they use to move. 0:11:37.520 --> 0:11:41.160 And swim like a little tail, little tail in fact, 0:11:41.280 --> 0:11:43.600 not just one little tail. Girardia. 0:11:44.120 --> 0:11:45.440 God, I did it again, didn't I. 0:11:46.600 --> 0:11:51.680 Giardia has four sets of flagella, so it actually has 0:11:51.720 --> 0:11:55.800 eight that it uses to swim around, and it has 0:11:55.920 --> 0:12:02.760 two adorable little nuclei that look like eyeballs. Giardia is 0:12:02.800 --> 0:12:05.720 one of the cutest parasites of all time in my opinion. 0:12:05.760 --> 0:12:07.760 I'm just gonna say, I think it is the cutest 0:12:07.800 --> 0:12:08.800 one we've done so far. 0:12:09.120 --> 0:12:09.400 It is. 0:12:09.760 --> 0:12:11.800 Yeah, I think it's one of the top cutest ones 0:12:11.880 --> 0:12:16.160 ever because it really looks just like a little person's head. Yeah, 0:12:16.200 --> 0:12:19.880 they're so cute. Okay, So, because this is a parasite, 0:12:19.920 --> 0:12:24.920 we get to talk about the life cycle as far 0:12:25.000 --> 0:12:30.200 as parasites go. Girardia has a very simple life cycle 0:12:30.240 --> 0:12:33.680 compared to a lot of parasites. It has two different 0:12:33.679 --> 0:12:37.599 life cycle forms. Inside of your intestine, it's called a trophozoite, 0:12:38.000 --> 0:12:40.079 and this is the form that looks like what I describe. 0:12:40.080 --> 0:12:42.200 So it has two big old nuclei that look like 0:12:42.280 --> 0:12:46.360 eyes and eight floppy flagella that look like hair running 0:12:46.440 --> 0:12:50.920 off of it. So the trophozoite form can swim through 0:12:50.960 --> 0:12:53.679 your intestine stick on to your gut walls. 0:12:54.000 --> 0:12:55.120 And then they also. 0:12:54.920 --> 0:12:59.160 Divide by fission, so one trophozoite can actually replicate and 0:12:59.200 --> 0:13:04.120 replicate and replicate all on its own. They also then 0:13:04.280 --> 0:13:08.079 form a cyst phase, and the cyst phase is what 0:13:08.120 --> 0:13:11.880 you're most likely to poop out and what ends up 0:13:11.920 --> 0:13:15.880 in the environment. You poop out trophozoides too, But the 0:13:15.960 --> 0:13:18.640 cysts are really important in their life cycle because the 0:13:18.760 --> 0:13:23.520 cysts are very resistant to environmental stressors, so they can 0:13:23.559 --> 0:13:27.720 survive in water like ponds and rivers and storm drains 0:13:27.760 --> 0:13:32.400 and mountain streams for weeks to months, and then when 0:13:32.440 --> 0:13:35.360 an unsuspecting animal comes by to take a drink from 0:13:35.360 --> 0:13:38.560 that beautiful mountain spring, they're going to get a big 0:13:38.600 --> 0:13:44.880 old mouthful of Girardia cysts, and then inside of your 0:13:44.920 --> 0:13:48.120 body or the animal's body, that cyst will then split 0:13:48.320 --> 0:13:52.280 and produce two trophozoites and begin the cycle all over again. 0:13:53.559 --> 0:13:57.400 How cool, right, It's beautiful and simple. I like it. 0:13:57.400 --> 0:13:57.960 It's simple. 0:13:58.040 --> 0:14:02.120 Yeah, it's simple. It's straightforward. Another thing that's very cool 0:14:02.200 --> 0:14:05.680 about the cysts is that they're resistant to a lot 0:14:05.760 --> 0:14:09.800 of the common ways that we disinfect water, including chlorination 0:14:10.120 --> 0:14:15.480 and ozone nation or whatever you call it o zonification. 0:14:16.440 --> 0:14:19.640 But the chlorination is the chlorination that we use to 0:14:19.680 --> 0:14:24.000 treat the drinking water high enough to kill Giardia nod dude. 0:14:24.280 --> 0:14:26.200 You have to filter it or you have. 0:14:26.080 --> 0:14:31.920 To boil it. Oh, Girardia can live in your pool 0:14:32.240 --> 0:14:34.800 for up to like forty five minutes, not for a 0:14:34.840 --> 0:14:35.240 long time. 0:14:36.440 --> 0:14:38.560 Huh interesting yes. 0:14:39.600 --> 0:14:40.760 Mm hmmmmmmmm. 0:14:41.120 --> 0:14:44.560 And when you're infected with it, you can poop out 0:14:44.680 --> 0:14:49.600 between one and ten billion with a b cysts. 0:14:49.800 --> 0:14:50.920 Every time you. 0:14:50.960 --> 0:14:53.680 Poop ten billion is a lot of cysts. 0:14:53.760 --> 0:14:56.680 It's a lot of cysts. And guess how many cys 0:14:56.840 --> 0:14:58.400 it takes to get you sick. 0:14:58.920 --> 0:15:02.280 Probably one, well, usually about at least ten. 0:15:07.200 --> 0:15:11.280 Anyways, So that's why it's really really common to get 0:15:11.320 --> 0:15:14.840 girardia from contaminated water sources. That's one of the most 0:15:14.840 --> 0:15:18.560 common ways that we think about the transmission of giardia 0:15:19.120 --> 0:15:23.400 is from contaminated water. However, you can also get infected 0:15:23.440 --> 0:15:26.600 directly with trophozoites, which you're also pooping out at the 0:15:26.600 --> 0:15:30.080 same time that you poop out cysts. So other places 0:15:30.120 --> 0:15:33.120 that you can get infected are places that have a 0:15:33.120 --> 0:15:38.640 little bit less hygiene, like maybe daycare centers AHA, which 0:15:38.680 --> 0:15:40.640 are one of the most common places that we see 0:15:40.680 --> 0:15:45.240 outbreaks in for example the United States. Tiny humans poop 0:15:45.280 --> 0:15:49.080 their diapers, rub their hands in it, touch their friends faces. 0:15:49.480 --> 0:15:51.080 Everyone gets girardia. 0:15:51.480 --> 0:15:56.239 I mean, we see a lot of gi things, parasized 0:15:56.280 --> 0:16:01.160 pathogens that yeah, filthy, filthy, tiny hum yes. 0:16:02.480 --> 0:16:06.680 Okay, so let's talk about the symptoms. Symptoms can range 0:16:06.680 --> 0:16:14.160 from absolutely nothing entirely asymptomatic, just feeling normal, pooping out 0:16:14.200 --> 0:16:18.400 parasites without ever knowing that you're sick, to an acute 0:16:18.480 --> 0:16:21.160 illness that pretty much is self limited so you have 0:16:21.240 --> 0:16:24.120 diarrhea for a short time and then you get better, 0:16:24.840 --> 0:16:28.760 to some pretty severe chronic infections that can result in 0:16:28.840 --> 0:16:32.000 things like weight loss and malnutrition. 0:16:33.280 --> 0:16:38.040 Question yes, what proportion are asymptomatic versus symptomatic. 0:16:38.440 --> 0:16:39.320 That's a good question. 0:16:39.400 --> 0:16:41.800 I haven't found an exact number on that, and in 0:16:41.840 --> 0:16:44.040 the epidemiology section we'll talk a little bit about why 0:16:44.080 --> 0:16:46.280 that's hard. But it does seem to be a pretty 0:16:46.360 --> 0:16:50.000 high proportion, and it depends on what strains of the 0:16:50.040 --> 0:16:53.240 parasite are circulating in the area, because different strains are 0:16:53.280 --> 0:16:57.280 more likely to produce asymptomatic infections than symptomatic infections. 0:16:57.800 --> 0:16:58.600 It's a good question. 0:17:00.120 --> 0:17:03.120 So the variability and presentation, like I said, is partially 0:17:03.240 --> 0:17:06.720 due to the virulence of the pathogen, like which one 0:17:06.760 --> 0:17:09.439 you end up getting infected with, but it also has 0:17:09.480 --> 0:17:13.200 a lot to do with your own host immune factor, 0:17:13.440 --> 0:17:17.000 so just something about you that makes you more likely 0:17:17.119 --> 0:17:21.040 to get a symptomatic infection. And then also the infectious dose. 0:17:21.119 --> 0:17:23.560 So how many of those cysts did you actually swallow? 0:17:25.040 --> 0:17:30.639 So let's talk about how it causes these symptoms, because 0:17:30.640 --> 0:17:32.040 I'm really excited about it. 0:17:32.200 --> 0:17:32.920 Yes, me too. 0:17:33.840 --> 0:17:39.800 So the biggest symptom that you get with grdiasis is diarrhea. 0:17:40.440 --> 0:17:45.399 You also get generalized abdominal pain, maybe distinctionion, maybe it 0:17:45.440 --> 0:17:48.800 feels big. Maybe you get nausea and vomiting. You can 0:17:48.840 --> 0:17:56.760 definitely get that from infection with GRDA getting better, but 0:17:56.840 --> 0:18:00.920 diarrhea is the number one. So it turns out that 0:18:01.040 --> 0:18:05.240 we don't know everything about how it causes these symptoms, 0:18:06.720 --> 0:18:09.800 but we do know a few things. So first of all, 0:18:10.560 --> 0:18:17.600 Giardia does not invade your intestine wall, so unlike something 0:18:17.640 --> 0:18:19.840 like hookworm that when it gets in is going to 0:18:19.920 --> 0:18:23.080 make a hole in your intestine and like actually punch through, 0:18:23.520 --> 0:18:27.240 Giardia doesn't do that. What it does is it has 0:18:27.240 --> 0:18:30.320 on its ventral surface, so on the opposite side of 0:18:30.320 --> 0:18:34.080 where the flagella are, it has this adhesive disk, so 0:18:34.119 --> 0:18:37.920 it uses its flagella to swim through your intestine up 0:18:37.960 --> 0:18:40.600 to the wall of your intestine, and then it uses 0:18:40.640 --> 0:18:44.639 this adhesive disk to just suction cup on to the 0:18:44.680 --> 0:18:49.040 wall of your intestine and then do what and then 0:18:49.280 --> 0:18:53.960 absorb your food essentially and just live and replicate. And 0:18:54.000 --> 0:18:57.200 they replicate by fission, so you don't need to have 0:18:57.800 --> 0:19:01.800 multiple parasites to replicate. They just replicate the way that 0:19:01.800 --> 0:19:04.800 bacteria do. They just divide. They don't sexually reproduce. 0:19:05.920 --> 0:19:10.040 There is some question as to whether they do sexually reproduce. 0:19:10.240 --> 0:19:13.240 They definitely do recombination, which is cool. 0:19:13.840 --> 0:19:17.760 Yeah, there's some really interesting articles that are like sex 0:19:17.760 --> 0:19:20.160 in the dark. Does giardia have sex in the dark 0:19:20.240 --> 0:19:21.000 or something like that. 0:19:21.240 --> 0:19:23.360 It would be pretty dark in your intestine. 0:19:23.560 --> 0:19:24.119 Yeah. 0:19:24.320 --> 0:19:29.800 But so how long does an average giardia infection last 0:19:29.920 --> 0:19:30.760 if untreated? 0:19:31.200 --> 0:19:34.199 It's hard to say because in some cases it can 0:19:34.280 --> 0:19:37.919 cause a really prolonged chronic infection. If you just have 0:19:37.960 --> 0:19:40.879 an acute infection, it'll probably resolve in a number of weeks, 0:19:40.960 --> 0:19:43.639 but some people can be infected for months and months. 0:19:43.880 --> 0:19:45.760 Okay, So it's it's. 0:19:45.560 --> 0:19:47.600 A very difficult thing to put like a straight number 0:19:47.600 --> 0:19:49.880 on the incubation period. So the time from when you're 0:19:49.880 --> 0:19:52.919 first infected to when you start showing symptoms is usually 0:19:52.920 --> 0:19:58.720 between one and three weeks, okay, Okay. So, once this 0:19:58.760 --> 0:20:05.239 parasite is a onto your intestine wall, they have a 0:20:05.359 --> 0:20:07.960 number of different mechanisms that again none of them are 0:20:07.960 --> 0:20:11.560 completely well understood, but these are the things that end 0:20:11.640 --> 0:20:16.760 up resulting in you having potentially massive diarrhea. So first 0:20:17.240 --> 0:20:22.560 is that they basically induce the cells, the epithelial cells 0:20:22.600 --> 0:20:27.840 lining your intestine to start undergoing apoptosis, which is cell suicide. 0:20:28.080 --> 0:20:29.479 That's bad news, I know. 0:20:29.800 --> 0:20:32.439 So they don't directly kill any of your cells, but 0:20:32.480 --> 0:20:36.479 they kick somehow something that they're releasing causes those cells 0:20:36.520 --> 0:20:40.760 to start undergoing apoptosis and essentially dying. So what that 0:20:40.880 --> 0:20:44.360 is going to do is increase the permeability of that 0:20:44.400 --> 0:20:49.000 epithelial cell layer. So normally the cells of your intestine, 0:20:49.040 --> 0:20:52.480 you can imagine, are very tightly packed because you only 0:20:52.520 --> 0:20:54.879 want certain things to pass through. Right, you want to 0:20:54.920 --> 0:20:58.560 absorb nutrients but leave a lot of stuff in your intestine. 0:20:58.560 --> 0:21:02.280 You want to absorb water, but not too much water, 0:21:02.560 --> 0:21:05.200 et cetera. Right, it's a very fine balance the whole 0:21:05.240 --> 0:21:09.159 process of digestion. So you're basically poking a bunch of 0:21:09.200 --> 0:21:15.200 holes by destroying these cells lining your intestine. On top 0:21:15.280 --> 0:21:20.560 of that, they flatten the microvilli. So microvilli are the 0:21:20.600 --> 0:21:25.359 protrusions on your intestinal wall that increase surface area to 0:21:25.400 --> 0:21:29.800 be able to absorb water and nutrients. If you flatten those, 0:21:30.080 --> 0:21:32.760 then you decrease the surface area. Then you can't absorb 0:21:33.160 --> 0:21:37.080 that water and nutrient as well. So what that means 0:21:37.160 --> 0:21:41.480 is that in combination, when you have increased permeability and 0:21:41.520 --> 0:21:46.040 then you also have a decrease in the microvilli, you're 0:21:46.080 --> 0:21:51.600 completely messing up digestion essentially and absorption. What that means 0:21:51.680 --> 0:21:55.159 is that you're gonna end up with more stuff left 0:21:55.280 --> 0:21:58.320 in your intestine, and that's going to pull even more 0:21:58.400 --> 0:22:01.719 water out from your cells into your intestine instead of 0:22:01.760 --> 0:22:04.639 the other way. So that means that you're left with 0:22:04.720 --> 0:22:09.440 a watery stool. And that's what diarrhea essentially is. Right, 0:22:09.840 --> 0:22:13.399 It's like your food is passing through without actually getting absorbed. 0:22:15.160 --> 0:22:18.400 Does diarrhea have to be three times in twenty four 0:22:18.400 --> 0:22:19.000 hour period? 0:22:19.680 --> 0:22:24.000 This is that's a very good question. No, there's no 0:22:24.160 --> 0:22:28.120 official definition on how you classify diarrhea. Usually we say 0:22:28.160 --> 0:22:31.560 three stools in three loose stools in twenty four hours 0:22:31.640 --> 0:22:33.840 is when you can start being like, oh, I have 0:22:33.960 --> 0:22:37.760 diarrhea and not just like one bad poop or something 0:22:37.800 --> 0:22:38.040 like that. 0:22:38.280 --> 0:22:40.600 But it's not an official official definition. 0:22:40.960 --> 0:22:41.360 Okay. 0:22:41.600 --> 0:22:44.199 Yeah. 0:22:44.240 --> 0:22:47.639 On top of that, there have been studies that show 0:22:47.800 --> 0:22:54.119 that girardia giardia increases the rate of transit through your intestine, 0:22:54.560 --> 0:22:57.560 so your food is moving faster, and if it's moving faster, 0:22:58.040 --> 0:23:00.480 then your body can't absorb everything that's in it. So 0:23:00.520 --> 0:23:04.600 that's another way that it can cause diarrhea and malnutrition. 0:23:04.720 --> 0:23:07.120 Because if it's moving so fast that you can't absorb 0:23:07.520 --> 0:23:12.359 what's in there, boom, dude, no good hmm. 0:23:13.080 --> 0:23:17.760 I wonder if what you eat affects any of these things? 0:23:17.840 --> 0:23:20.639 Oh, what a good question. That's a very fun question. 0:23:22.359 --> 0:23:26.640 There's more, Okay, on top of all of that, there's 0:23:26.680 --> 0:23:31.919 some evidence that giardia causes hyper secretion of electrolytes. So 0:23:31.960 --> 0:23:35.280 on top of not allowing your intestine to properly absorb 0:23:36.200 --> 0:23:40.639 electrolytes and other things in your intestine, it causes the 0:23:40.800 --> 0:23:45.600 secretion of electrolytes from your cells into your intestine. And 0:23:45.680 --> 0:23:48.600 wherever electrolytes go, water goes. 0:23:48.880 --> 0:23:49.520 So now you have. 0:23:49.600 --> 0:23:53.320 Even more water going from your body into your intestine 0:23:53.320 --> 0:23:54.560 instead of the other way around. 0:23:55.480 --> 0:23:58.720 Definitely kicking you when you're down. It's not content to 0:23:58.920 --> 0:24:03.520 just like ringes a little bit. Is like no, completely dry, 0:24:04.240 --> 0:24:08.080 completely dry, burning some bridges there, right. 0:24:08.320 --> 0:24:12.600 And so that's all of sort of the diarrhea based 0:24:12.800 --> 0:24:18.480 things that giardia. Giardia does, Okay, okay, pretty cool. 0:24:18.840 --> 0:24:20.160 It's a lot and. 0:24:20.119 --> 0:24:22.920 We don't fully understand exactly how it happens, but it's 0:24:22.920 --> 0:24:24.919 easy to see how the few things that we do 0:24:25.080 --> 0:24:30.359 know can end up leading to maldigestion, so losing nutrients, malabsorption, 0:24:30.640 --> 0:24:33.359 not being able to absorb these nutrients. So if you 0:24:34.040 --> 0:24:36.480 if you are not able to fight this parasite off, 0:24:36.520 --> 0:24:38.840 and you have it chronically, it's easy to see how 0:24:38.840 --> 0:24:42.119 this can become a pretty serious infection that leads. 0:24:41.880 --> 0:24:43.200 To poor nutrition. 0:24:43.920 --> 0:24:45.280 Yeah. 0:24:45.520 --> 0:24:48.119 Now here's some things that I didn't really realize when 0:24:48.160 --> 0:24:49.280 I started researching this. 0:24:50.359 --> 0:24:54.800