306: Parasites, Worms + Skin Rashes w/ Robin Foroutan, RD

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If you've ever wondered if parasites could be a factor for your rashes + other health challenges, have I got a mind-blowing episode for you!

Parasites can be helpful in some instances, but they can also be a problem for others (especially when there's a parasitic infection). Whether doing a parasite cleanse is the right thing to do (or will lead to a really negative reaction) is what my guest who was introduced to me as the “Queen of Parasites” will dish on.

Joining me today is Robin Foroutan, a leading expert in Integrative and Functional Nutrition and holistic health who firmly believes that the body is able to heal itself given the right conditions. By seeking out root causes and underlying imbalances that cause symptoms, and using an advanced, natural and biological approach to address those root causes, she helps her clients create the conditions that encourage the body to heal itself. She sees clients through her virtual practice, Nutrition by Robin, and is a nutrition consultant, lecturer, and writer.

Have you ever done a home parasite cleanse or done one with a practitioner? Tell me what worked (or frankly if you're just grossed out!) in the comments below!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

  • Different types of parasites (and why some are “bad”)
  • Reasons why parasitic infections so commonly overlooked or ignored (both in functional + conventional medicine)
  • Will testing for parasites give you a definitive answer?
  • The LONG list of symptoms connected to parasites
  • Why parasites cleanses, parasite purges + parasite detoxes can go HORRIBLY wrong


“If somebody has a fungal infection that they just can't kick, if that candida just will not quit, you have to think something else bigger is shielding the candida.” [09:41]

“There are periods of time that coincide with the moon cycles where parasites and worms are more active. So that's full moon, new moon. So if you are having cyclical symptoms where once or twice a month, you have a really itchy butt, your stomach is bothering you, you get a skin outbreak, or just feel exhausted or cranky or whatever… cyclical symptoms are typically infectious in nature.” [10:56]


Find Robin online | Instagram | Pinterest

Healthy Skin Show ep. 129: Are Skin Rashes Caused By Parasites?

Healthy Skin Show ep. 213: Stool Testing Do’s + Don’t’s For Skin Rashes

Healthy Skin Show ep. 032: What's Going On Beneath Hives w/ Dr. Alan Dattner


306: Parasites, Worms + Skin Rashes w/ Robin Foroutan, RD FULL TRANSCRIPT

Jennifer Fugo (00:08.466)
Robin, thank you so much for being here.

Robin Foroutan (00:11.266)
Thanks for having me.

Jennifer Fugo (00:13.178)
I'm excited because we are going to talk about parasites. And I will share that the way I was introduced to you was that you were like the queen of parasites. I think that was the phrase. And you definitely know a lot. We had that, I'll just never forget, and you guys might appreciate this, we were sitting in a bar. So there's a lot of people around us and we're talking about poop, parasites, parasite cleanses and all sorts of things. And the people around us as they're eating are giving us some awful looks because like, look… We don't find it gross because we live and breathe and work in this space, but the normal person, I could see how it could be squeamish. So let's talk about parasites. I think we should ground the conversation with what are parasites and what the different types of parasites that there are.

Robin Foroutan (01:00.629)
Yes. Oh yeah, okay, so parasites are sort of a broad category of the types of nasty critters that are not really meant to be in the gut. And so some of them are microscopic, you wouldn't be able to see them with the naked eye. Some of them…are larger like parasitic worms, which is one of the things that I specialize in because what I found was it's this major blind spot, not just in mainstream medicine for sure that it's that it is not on their radar, but even within integrative and functional medicine, the pervasiveness of these kinds of parasitic worms in particular that disrupt the gut microbiome, it's really underappreciated. And part of that is because it doesn't show up readily on tests.

Jennifer Fugo (02:02.75)
That is true. That is true. And I think we should say that not all parasites are bad. I think most people have the idea that they're just bad, but that's not actually the case, right?

Robin Foroutan (02:16.546)
Well, you know, the thing is, is that if you're alive and breathing, you have parasites. And that is fine. You will, there's no such thing as eradication for any of these things. And it's really, it's only a problem when it becomes like an infection when it's overgrown. And so I'm sure you talk to your audience all the time about like things like candida and like fungal things that are, you know, fungal things are, it's meant to be in our gut. And I think the same thing about worms. It gets a little dicey when you call them parasitic worms because once you use the word parasite, it kind of suggests that it's bad, but not really. So it is most likely natural and normal to have worms in the gut. And it's really only a problem when they overgrow to a point where now it is disrupting your bodily function. So like your gut immune system, it's putting a burden on your detox system and it has now become a problem and you're having symptoms. But for most people, everybody's got parasites. They're not going to be a problem for everybody.

Jennifer Fugo (03:28.382)
And with identifying parasites, because we have protozoas, and we have the worms, as you said. And there's also some worms, which I don't remember the woman's name, the naturopath who was with us the day we met. But she was talking about how some helminths are actually helpful. And I've had Dr. Heather Zwickey on the show talking about how some helminth therapy can be beneficial for allergy reduction. But it was just interesting to hear that take on things that not all worms are necessarily bad. There's some that we've, I guess, essentially evolved with and could be helpful. But they also are missed a lot as you touched on. And why do you think that is?

Robin Foroutan (04:12.093)
You know, parasitic worms kind of disintegrate when they die. So if you take an anti-parasitic and the parasite dies, it releases enzymes that kind of degrade itself. So you'll never find a dead parasite on a stool test. You can hope to find eggs, you can hope to find larvae, you might find a weakened one, but you can't find a dead one. So some tests are not even looking for them. So obviously you're not gonna find what you're not looking for. And then even some of the best tests, I am firm in my belief that they're really not capable of finding them. Even some of the stool tests that I really admire and use and love and think they're great in a lot of other ways, I also know that they're very hit or miss for yeast and candida and they will miss parasitic worms. Not so much the protozoa and like those kinds of microscopic. They're pretty decent at finding those things, but you have to keep in mind that you're only finding whatever you pooped out in that sample, so you can't you can't possibly test for what is in the entire microbiome. We don't know enough about it. Stool testing is the best that we have but by far it's not perfect. It's not by a long shot. So you know I think it's really important in at least in my practice to listen very carefully and kind of be able to draw lines between the dots and say oh okay here's the chronology of the things that happen. Here's how it's manifesting and what could it possibly be because an overgrowth of parasitic worms- there's like there's a sound to it. There's a rhythm to it. There's specific sets of symptoms and so you can kind of Guess- make a really good educated guess when you think that might be a problem.

Jennifer Fugo (06:17.658)
So in terms of skin and symptoms, I would definitely argue that, like, when someone presents with chronic hives or urticaria or dermatographia, I'm definitely like, what's going on here? Like, they're getting a hard side eye of what the heck is going on with their case, which is so funny because it's often overlooked. And for listeners, they know that, for example, so we've got a lot of people who have eczema, if you take or if you're prescribed dupilimab, which is known as Dupixent, which is an IL-4, IL-3 blocker, their warning on the drug is do not use if you have a helminth infection. So I have asked every single rep who I have seen at any show or meeting that I have been at, I said, well, how's that supposed to happen? Because does a derm test for this? And she's like, oh no. And it's always women. So when I say she, that's why. I've only ever met female reps from, I don't recall the company name, but it's always the Dupixent booth. And I'm like, well, the patient should alert the doctor. And I'm like, how the heck is the patient supposed to know? Right, no one tests.

Robin Foroutan (07:34.062)
They don't know. Right. It's the same thing, you know, those same kind of warnings where it's like, don't take this drug if you have a parasitic infection, how would you even know? And don't take this drug if you have a fungal infection. And it's like, well, that's kind of everyone who is unwell in a specific set of circumstances.

Jennifer Fugo (07:55.002)
Exactly. And it almost seems like it's an on-off switch. Like, if you don't have a fungal problem, or you do have a fungal problem. But the truth is, there's shades of gray. And how do you know if your shade of gray is maybe veering too close, right, to the problem? It just doesn't show as an overt infection where you have thrush or a vaginal yeast infection or something like that. It just still could be hugely overgrown internally. So anyway, long story short, it was just interesting that we're relying on these tests that, number one, don't do a good job. Number two, they're so infrequently, even just from a conventional standpoint, it's not common that the ova and parasite stool test is even done. And they oftentimes pick up very little from my experience. So, aside from the dermatographia and the hives, what are some other things, whether they're skin related or other symptoms, would be red flags for you that… We're gonna put the caveat here that we're not saying 100% that you have a worm, but could suggest or be indicative that you should perhaps explore the option of whether you have worms.

Robin Foroutan (09:11.334)
Yeah, I think there's specific cases. As you said, chronic hives, definitely. Think about parasites. Dermagraphia, definitely think about parasites. Those kinds of big histamines, MCAS, which stands for Mass Cell Activation Syndrome, is very often gonna be parasites, mold, or both. Because a lot of times these things live together. And that's the body's attempt at maintaining a homeostasis. It's not a negative thing, it's just how it is. If somebody has a fungal infection that they just can't kick, if that candida just will not quit, you have to think something else bigger is shielding the Candida. So that's something to consider as well. And then acne, specifically cystic acne in my experience can also be related to parasites. So if you're not clearing infections, if you're really stuck in that gut game where you keep testing and there's it's like whack-a-mole, there's this infection then there's that infection and you can't quite get to resolution, you have to think that there's something else in there that's not being picked up that's shielding these other things. So that's kind of the way that I think about it. And then separately, there's these like weird nocturnal behaviors. So first of all, there's itchy butt. If your kid has itchy butt hole and it's pretty significant and it lasts a long time and it's not just because they didn't wipe that well, same thing for adults, you should think about maybe there's a parasitic infection.

There's also a phenomenon, and I know that this sounds like super weird and witchy, but I have found it to be mostly true most of the time. There are periods of time that coincide with the moon cycles where parasites and worms are more active. So that's full moon, new moon. So if you are having cyclical symptoms where like once or twice a month, you have a really itchy butt or your stomach is bothering you or you get a skin outbreak or just feel exhausted or cranky or whatever… or hungry, cyclical symptoms are typically infectious in nature. And that's just something that I've sort of honed in on. I've been in practice, I don't know, I think it's like 18 or something years now. So cycles mean infections. Check out the moon cycle. If you always feel worse around a full moon, that's probably a sign that there's some kind of parasite. It doesn't mean parasitic worms. There's other types of bloodborne parasites as well, like Babesia.

Feeling really hungry even after eating and you've eaten enough food. What people will typically describe is this like empty pit feeling even after they've eaten. It's ravenous hunger at night. Some of my parasite clients wake up in the night to eat. They're they're like starving in the middle of the night and they can't wait until morning. These are abnormal eating behaviors and hunger patterns. And that's also a clue. Some people can eat a huge plate of food but if there's not a starchy starch, they can't get that kind of relief that comes with fullness. They just feel this gnawing hunger that's still there until they eat something that is feeding that particular microbe. And then it's like a whoosh of relief that they can feel like good and full and whole. So funny eating habits or eating patterns, hunger patterns, itchy butt for sure. Skin things. I mean, sometimes it's just funny things in the toilet. Like you can see eggs with the naked eye. You could I mean, you could mistake it for rice. So it's not proof positive. I mean, if you have undigested food in your stool, maybe that's not the best way to kind of evaluate yourself. But if you were doing, say, like a yeast protocol and you notice that there's a lot of like funny little white, like almost like rice bits in your stool, that's a big egg push. And so you might actually be seeing worm eggs, not quite candida. So there's a lot, there's a lot of things to look at and they all sound really weird.

Jennifer Fugo (13:51.318)
I hope no one is eating while you're listening to this. Because if you're one of those people that's grossed out by this talk, I'm sorry.  And what about different jaw issues as well, or sleep disturbances like nightmares, night terrors, crazy dreams? Do you find that clients have those issues as well?

Robin Foroutan (13:58.806)
This is not the podcast for you to listen to while you're eating if that bothers you.

Robin Foroutan (14:19.222)
I don't know about the crazy dreams. I don't know that that comes up all the time, but bruxism, which means teeth grinding and teeth clenching, that is a big potential sign. So could be dark under eye circles. Things like people who are just kind of low iron all the time for no reason, or like low in specific minerals even though they're supplementing, low in some of the B vitamins even though they're supplementing and like can't catch up to their nutritional needs. Things like unintended weight loss, where all of a sudden you're dropping all of this weight and you haven't changed anything. That's a big sign. Another potential sign is gaining a lot of weight without changing anything. So that's the funny thing about these kinds of parasites is that it could go either way. Either you can lose a lot of weight because they're eating your nutrients and you're not getting getting enough. And that could be tapeworm, it could be other kinds of worms, or they're creating so much inflammation in the gut that the body decides that it needs to store more energy and store more fat as a buffer to protect you from the inflammation. So it could either go, it could actually go either way with parasites.

Jennifer Fugo (15:37.27)
Fair enough. So I wanna ask you this because I think that if you go on Facebook and on social media, there seems to be this big push toward doing parasite cleanses. And I've had some clients who have done them on their own and just like dove in head first, two feet, whatever, either way they're diving, they're just going all in and they had a very horrifying experience, unfortunately. Some who had huge histamine flare ups, felt really sick. So, what would you say to someone who is looking at all this social media information and they're also possibly still doing things on their own, which is fine. There's nothing wrong with that. But are there some boundaries or rules of thumb or something to, even like you work with clients, I would imagine that you maybe the slow and steady approach might be better than just like let's go hardcore. Or you tell me because this is your area of expertise.

Robin Foroutan (16:45.362)
It depends, it really depends on the client. If you are like… Rah rah rah, let's go super, super hard. And you're in excellent physical health. You are very regular. You poop once or twice a day. You don't have any digestive issues. You don't have any allergies or food sensitivities. And you're really in very robust shape. Go into a little cleansing cleanse. It's probably not a big deal for you. But that's not generally who is looking for those types of things.

What you have to do first is make sure what's called your drainage pathways are open. Because when you kill things in the gut, you don't have to just expel the actual things that die, but they release a lot of toxin, and you have to be able to handle that increased toxic burden as well. So liver might need support, lymphatic drainage might need support, your kidneys might need support, you might need to sweat. If you're somebody who's prone to having detox reactions through the skin. And I mean, you probably know more about this than I do, but it just seems to me that there's sort of a proclivity. Each body has its own proclivities and some people's skin is the major detox organ for them and it's probably because liver, kidney, lymph are a little bit junked up and they need that extra exit strategy so it's going to jump it through the skin because that's pretty reliable. But if you're someone who has like struggled with quote detox or you are at a very low weight or you have a complex set of conditions or you're on medications or whatever, whatever. A lot of people, I will say most people need to do some prep work ahead of time to make sure that their detox and drainage pathways are open. So if you're a constipated person, you better resolve that constipation before you do anything else because it is going to be a rough road for you because you're not going to be able to clear the toxins. If you're chronically dehydrated. Same story. If you're living in mold, same story. And now a lot of us don't know, but if you're very histamine-y that might be a sign. If you have a lot of food sensitivities you've got some gut work to do first. So there and then there's a delicate balance when you're actually doing the parasite protocol. This is where a lot of people who do it on their own run into trouble.

You've got to make sure the detox pathways are open and supported and then you can put in the killers, the killing herbs, and then you also want to bind. So you want to bind, you want to hydrate, you want to make sure that you're pooping. If you're someone who feels comfortable getting colonics or doing enemas at home, these are really good strategies because if the toxic burden overwhelms what your body is able to deal with, you're going to feel terrible and everything is gonna flare. And then it's sort of dicey of, is there a net positive in the end or did you just like kick up a lot of inflammation and really didn't see a benefit to the whole thing? Cause it should be beneficial and should be beneficial for everyone. Cause as I said, we all have these kinds of microbes. We could all deal with like a nice little parasite purge once or twice a year. Maybe after travel, maybe more frequently, if you have a lot of pets or if you have pets that you like to kiss on the mouth.

If you have kids playing in sandboxes, if the kids come back with pinworm and these kinds of things that are very, very common. If you eat a lot of sushi or raw things, you know, you just have to think about where your exposures are. But I would say, work with somebody for the first few times so that you can get the hang of it. And then, you know, you might be able to do it on your own after that, unless you run into trouble. But it's more than just kind of like taking some parasite formula and calling it a day or like eating a bunch of papaya seeds. I mean, you could, it works. It does work. It is a thing. That TikTok was not a lie.

Jennifer Fugo (21:19.014)
It's just, it's one of those things where I get nervous sometimes because I realized too, that with some of the herbs, you do have to be careful of liver function. Some of them can be a little rough on the liver. And so doing, you know, I see online people are like, they're just doing nonstop parasite cleanse protocol, like endlessly. And I'm like, your liver enzymes could be struggling a little bit. You have to watch that. So with that being said, I guess approach-wise, just from a standpoint of both of us can't prescribe medication. So obviously, this is just what you've seen and what you've worked with within the practice, because I know you also work with a doctor on really complex cases. Do you think there's a time and a place for anti-parasitic meds? Or are meds, especially in the parasite realm? Are they just 100% bad? Because, you know, we have a lot of people listening who have a fear of antibiotics. So do parasite meds, do you think, just in your opinion, fall into that same category? Or do they serve possibly a time and a place for some individuals? And maybe do you still think if you do the meds, you might still need to do herbs too?

Robin Foroutan (22:29.31)
Mm-hmm. My philosophy is that you can sort of get yourself to a resolution of this kind of problem. Like I said before, we're not aiming for eradication. It's just not even possible. What we're aiming for is better balance. And to your point, if you're doing killing protocols, killing protocols, it's not like your beneficial microbes are completely immune to these herbs. You're culling everything. So you have to be mindful of not just your own organs and what the reaction is gonna be, but also you have to take good care of your beneficial microbes too, because in the end, that's who's gonna protect you from subsequent parasitic infections. We need the robustness of a healthy microbiome, and a lot of that comes down to our beneficial microbes who get to say, you can stay, you've gotta go, this is too much, we're gonna foster that. So that's the first point. I do think that there is a time and a place for anti-parasitic medications.

And most people have their own kind of idea of, you know, some people are like, oh God, I can't believe I tested positive for parasites. Ew, give me every drug. And so if that's how they feel about it, and we're working with a doctor who's keen on treating them that way, then we can do that. But you're not gonna get to the end of that road with medication alone. And I have the same philosophy with candida and yeast too. Like you can use antifungals, but you're going to need the herbs. Same thing for treating, you know, SIBO for instance. You can use the antibiotic, but you're gonna need to follow it up with herbs. So it's either herbs and only herbs or antimicrobials followed by the appropriate herbs.

Jennifer Fugo (24:22.698)
We have the same philosophy. I agree. It is. It is. And I feel so sad when people are like, it's got to be one or the other. And I'm like, really? Does it have to be? Why can't we marry the two and just do what's best for the person?

Robin Foroutan (24:39.666)
Yeah, because I've definitely worked with some clients where they had just been struggling for years and years and worked with the right kinds of health professionals and made a lot of progress, but they still had, you know, this is a very big sign when people come in and they say like they're super reactive to a long list of foods and that list of foods keeps getting shorter and shorter and shorter. That is a sign of parasitic infections. Same thing with sudden onset of actual food allergies where you know you hear these kinds of stories where people went somewhere on vacation, They got sick from the food 24-hour bug not anything to be you know that preoccupied with and then they come back and slowly slowly they develop allergies- true allergies- to food and That is also a sign of you know a disruption in the gut barrier and a lot of times that's kind of a parasitic worm to blame for that level of dysfunction.

Jennifer Fugo (25:41.594)
Well, we were talking. Well, we've just been we've been hashing it out. You know, it's so funny because like this stuff is so fascinating. You know what I mean? And I think that, as you said because there's been this over-reliance, I think there is an over-reliance personally on testing. So my dad, as I think you know, was a medical doctor. And one thing that he imparted to me was that testing is wonderful, but it can't always tell the full picture. And if something still doesn't look right, and granted, my dad was old school. He went to Hahnemann University in Philadelphia, which had a more kind of, I guess, slightly integrative-ish approach. I wouldn't call my dad integrative… but he definitely liked to, he was open-minded and he also did feel that if the symptoms still did not match the testing, we're not done figuring out what's wrong. And where I feel we've done a disservice with an integrative and functional medicine, and I think this is where you and I like really bonded a lot about this, is that everyone just goes, oh, your test looks clear. You're fine.

Robin Foroutan (26:49.814)
Ugh. That's the worst. I know, that's the worst. I'm thinking of this woman in particular who she got so much better with the integrative docs and finally got referred to me. And she kind of sat down and she was like, I've got like five foods. I've got five foods that I can eat. And she had done a bazillion stool tests, a bazillion food sensitivity tests. And like, no, it was clear that whatever it was, it was getting missed. And I sat down with her and I was like, you've got parasitic worms, you've got worms, you have parasites for sure, for sure. So we did some testing, found them, she was so relieved. But her thing was that she was so sensitive to things that herbs really messed her up. That she was, and she had kind of had these big kind of concerning reactions to so many different types of herbs that she was unwilling to try herbs again, which who could blame her. And so for something like that, we really led with prescription and over-the-counter medications because she was just uncomfortable taking the risk that she would have another reaction. Now, there are some herbs that are like so well tolerated that she actually did tolerate that well. But it was kind of a leap of faith to go there with her. But you know, once we started treating her for parasites and worms and we got her set up with someone to do colonics as well and we did our little like full moon protocol, new moon protocol, colonic colonic and you know we kind of got a cadence and a rhythm going. She was finally able to eat food again. I mean like she was just trying to eat rice. It was she wasn't asking for a lot but like she had I mean she could eat chicken and zucchini and like carrots and that was it. I mean it was really sad. Yeah and it really changed her life. She was able she wanted to go back to school and get a master's. She just couldn't! Her brain was too foggy, she just was in pain a lot, it was terrible. And so something like that gave her her life back. And that was primarily done with anti-microbial prescription medication just in a more open-minded dosing schedule. Because the typical dosing is like, here you take this for a day, or take this for three days. It's just inadequate when it's an old infection. Like that might cut it if it's a new infection, but if it's old, there's layers.

Jennifer Fugo (29:25.022)
Yeah. Well, I will say, this has been a very, for me at least, a super fun conversation. So I'm hoping that everybody listening is fascinated. I'm sorry if you feel slightly gross, because I'll be honest with you, it is really common when clients get like some of the other, we do other testing and I know you use some of these labs too of like you find worms and some people like freak out they have a meltdown because it feels you feel gross like finding out you have worms in your GI tract which they you know can move and all sorts of… It sounds like we need a part 2 to this conversation! But you are taking clients, right? You do work with clients virtually.

Robin Foroutan (30:11.146)
Yes. Yep. Yes, I'm seeing clients virtually.

Jennifer Fugo (30:14.134)
Perfect. And what I'll do is I'll make sure to put your website and everything of how to get in touch with you into the show notes. I have loved getting to know you over the last few months. And so I'm so excited to finally have you here on the show and share your amazing wisdom with everyone. And we will nerd out more on parasites and all of the amazing work that you do in another episode if you're willing to come back.

Robin Foroutan (30:41.226)
Would love that. Yes. Thank you for having me. It was a really fun chat. I hope everybody found it interesting.

Jennifer Fugo (30:48.486)
I'm sure they did. I did. So thank you so much, Robin. I appreciate it.

Robin Foroutan (30:53.67)
Thank you.

"If somebody has a fungal infection that they just can't kick, if that candida just will not quit, you have to think something else bigger is shielding the candida."

Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.

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