Understanding Parasites and Treatment Safety
DEAR DR. ROACH: I’ve come across information suggesting that millions may be harboring parasites without realizing it. I’m curious about how to cleanse safely. I’m not so keen on using animal medications like fenbendazole or ivermectin.
I drink clove tea every day, but I suspect that it’s not enough since it doesn’t cross the blood-brain barrier. What do you think? This is, after all, your area of expertise. — R.R.
ANSWER: It’s likely accurate that millions of Americans have undetected parasitic infections. The most common offenders are intestinal parasites such as Blastocystis or Strongyloides. While it might be disturbing to think about these parasites, we typically don’t recommend treatment for asymptomatic individuals, even if it has been diagnosed.
Microorganisms can be grouped into three categories: beneficial ones, like the trillions of healthy bacteria in our intestines; harmful pathogenic ones that cause illness; and commensals, which neither help nor harm us. In most cases, protozoans like Blastocystis fall into the commensal category, meaning treatment isn’t necessarily required. Instances requiring treatment of an asymptomatic parasite are very rare, particularly among U.S.-born individuals.
Clove tea is often considered a traditional remedy for certain parasites, but I don’t find it effective; thus, I don’t recommend it as a treatment.
The typical symptoms of intestinal parasites include diarrhea, abdominal pain, bloating, gas, anal itching, and unexplained weight loss. While parasites aren’t a common cause of these symptoms in the U.S., persistent symptoms should be properly evaluated, rather than treated with home remedies or strong antiparasitic medications unless prescribed after a solid diagnosis.
Ivermectin is used for parasitic infections in both humans and animals. Although fenbendazole isn’t approved for human use, similar drugs like albendazole can be used when treatment is appropriate. Infectious disease specialists are the go-to professionals for treating such infections.
Menopausal Concerns and Treatment Options
DEAR DR. ROACH: I’m a 70-year-old woman experiencing vaginal dryness that began post-menopause. My doctor has prescribed estradiol cream (0.01%) to alleviate the symptoms. However, the potential side effects and warnings are concerning, despite my doctor reassuring me of its safety. I’d truly value your perspective on this. — K.C.
ANSWER: The FDA mandates boxed warnings, which denote the highest level of concern, for systemic estrogen treatments such as pills. Until November 2025, similar warnings applied to topical options like creams and gels. I believe the risk associated with estradiol cream, as prescribed to you, is low. I support the removal of the boxed warning, which often discourages women from utilizing these beneficial, low-risk treatments for symptoms related to low estrogen levels, including vaginal dryness or discomfort during sex.
However, I always advise that anyone prescribed estrogen with a history of estrogen-sensitive tumors, such as breast cancer, should discuss this therapy with their oncologist before starting treatment. For most healthy menopausal women, topical estradiol is an excellent and very safe alternative.
