Migratory Skin Worms from Sushi

Migratory Skin Worms from Sushi
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Gnathostomiasis from raw fish is a growing problem, manifested by tiny worms that burrow under our skin and, in rare cases, can get into our eyes and brain.

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There was a report recently of a woman in San Francisco suffering from gnathostomiasis. I had learned about it in med school, but never actually saw a case, though evidently it’s now on the rise. Clinically, the disease commonly presents as migratory cutaneous swelling–bumps on the skin–that move around. Why? Because there’s a worm under there. They migrate through the subcutaneous tissues–under the skin–and cause recurrent episodes of migratory swelling or creeping eruptions. There is no effective treatment, really, other than removal of the worm. Here’s a picture of the thing. Note its head has these rings of little hooks that allow it to burrow through tissue.

Because humans are essentially a dead-end host for the larva, no further development into mature worms can occur, and symptoms are experienced owing to the wandering of the organisms throughout the body.

It can also crawl into our eyeballs. A 42-year-old woman with a four-year history of migratory swellings on her face. Then a little bleeding from the eyelid, and you know where this is going. No problem though. You can make a little cut, stick some forceps in, locate the worm, and then just pull the puppy out of the eyeball. But if you have any pimples on your face that move around, better to grab them before they start swimming around in your eyes.

By far the most serious manifestation, though, is when it gets into our brain. As the worm migrates along the nerves, the patient may experience excruciating pain. It can lead to paralysis, bleeding in the brain and finally death. But in non-cerebral disease, it’s the worms that die, though it may take about 12 years.

How do the worms get into our brain, though? So-called neurognathostomiasis These Gnathostoma worms are highly invasive parasites. After leaving the sushi bar, the larvae penetrate the wall of the intestine. They can then enter the brain through the base of the skull, crawling along the spinal nerves and vessels. They start out in the nerve roots, enter the spinal cord and then can climb up into the brain. The worm isn’t poisonous or anything; it’s just the migration of the worm through the body that causes direct mechanical injury because of tearing of nerve tissue.

Bottom line, this diagnosis should be considered in patients who present with nonspecific little lumps and bumps, especially when there is a history of frequent consumption of raw fish.

Thankfully, most raw foodists stick to plants, and thereby avoid things like this. A 21-year old experienced acute, severe pain in her mouth immediately after swallowing a raw squid. Seems consumption of a squid with sperm bags and an active ejaculatory apparatus can lead to unintended ejection of the sperm bag and injury to the oral cavity. The habit of eating raw food, especially living organisms… is risky. Though, some living organisms (plants) are substantially less risky than others.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Heike Rau.

There was a report recently of a woman in San Francisco suffering from gnathostomiasis. I had learned about it in med school, but never actually saw a case, though evidently it’s now on the rise. Clinically, the disease commonly presents as migratory cutaneous swelling–bumps on the skin–that move around. Why? Because there’s a worm under there. They migrate through the subcutaneous tissues–under the skin–and cause recurrent episodes of migratory swelling or creeping eruptions. There is no effective treatment, really, other than removal of the worm. Here’s a picture of the thing. Note its head has these rings of little hooks that allow it to burrow through tissue.

Because humans are essentially a dead-end host for the larva, no further development into mature worms can occur, and symptoms are experienced owing to the wandering of the organisms throughout the body.

It can also crawl into our eyeballs. A 42-year-old woman with a four-year history of migratory swellings on her face. Then a little bleeding from the eyelid, and you know where this is going. No problem though. You can make a little cut, stick some forceps in, locate the worm, and then just pull the puppy out of the eyeball. But if you have any pimples on your face that move around, better to grab them before they start swimming around in your eyes.

By far the most serious manifestation, though, is when it gets into our brain. As the worm migrates along the nerves, the patient may experience excruciating pain. It can lead to paralysis, bleeding in the brain and finally death. But in non-cerebral disease, it’s the worms that die, though it may take about 12 years.

How do the worms get into our brain, though? So-called neurognathostomiasis These Gnathostoma worms are highly invasive parasites. After leaving the sushi bar, the larvae penetrate the wall of the intestine. They can then enter the brain through the base of the skull, crawling along the spinal nerves and vessels. They start out in the nerve roots, enter the spinal cord and then can climb up into the brain. The worm isn’t poisonous or anything; it’s just the migration of the worm through the body that causes direct mechanical injury because of tearing of nerve tissue.

Bottom line, this diagnosis should be considered in patients who present with nonspecific little lumps and bumps, especially when there is a history of frequent consumption of raw fish.

Thankfully, most raw foodists stick to plants, and thereby avoid things like this. A 21-year old experienced acute, severe pain in her mouth immediately after swallowing a raw squid. Seems consumption of a squid with sperm bags and an active ejaculatory apparatus can lead to unintended ejection of the sperm bag and injury to the oral cavity. The habit of eating raw food, especially living organisms… is risky. Though, some living organisms (plants) are substantially less risky than others.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Heike Rau.

Doctor's Note

This is like my Tongue Worm in Human Eye or Cheese Mites and Maggots videos. Extremely rare, but extremely fascinating (to me at least!). There is one parasitic infection that is much more common and a major cause of disability worldwide, neurocysticercosis:

I think the only other sushi videos I have are Fecal Contamination of Sushi and Allergenic Fish Worms, though the nori is good for you (Which Seaweed is Most Protective Against Breast Cancer? and Avoiding Iodine Deficiency).

If you haven't yet, you can subscribe to my videos for free by clicking here.

71 responses to “Migratory Skin Worms from Sushi

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      1. or the cruelty of catching/killing fish -which often also entails torturing/killing other animals- and the very real possibility that they were caught by human slaves.




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  1. If you eat vegetable maki rolls made at a sushi bar, is there any chance of the workers who make them having the worms on their hands or on the countertops and getting them into the veggie rolls?




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    1. I dont think this a common disease. On the other hand I am sure that you will get all kinds of goodies from the fish that they prepare in the same place…




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  2. This is a bit misleading. Properly prepared sushi fish is frozen, then thawed, prior to service, and that should take care of any living organism. The same thing is accomplished when you cook fish, which of course harbors the same organisms. Did you know you eat cooked worms when you eat fish?
    In any case, this is just one more reason to stick to veggies.
    Al Davis




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    1. I’ve heard this before – but freezing doesn’t kill all living organisms. I mean even when you freeze other flesh, the freezing of it doesn’t kill the bad bacteria you still have to cook it or risk e-coli etc….
      Can someone answer if freezing the fish makes any difference to these worms?




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      1. From this brief review:

        Freezing (-4°F (-20°C) or below (internal or external) for 7 days or -31°F(-35°C) or below (internal) for 15 hours) of fish intended for raw consumption also kills parasites. FDA’s Food Code recommends these freezing conditions to retailers who provide fish intended for raw consumption.

        Its fairly alarming that Anisaksis simplex is extremely common in some fish species (eg 87% of wild salmon), and some is processed with inadequate freezing and cooking temperatures. The major danger from sushi is still probably the mercury in predatory species.




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        1. “Flash freezing” is the proper sort of freezing for fish to be eaten uncooked as it doesn’t muck up the texture as does “regular” freezing. Don’t eat discount sushi! Yes I have, but ne’er again. Never even consider eating freshwater fishes uncooked.

          Pay for the good stuff by the best chefs, that should keep your consumption reasonable! (if you roll that way)




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          1. It is good to have guidelines but they must be followed… proper technique, trained personnel, proper calibrated equipment, etc. Of course you can lower the likelihood of getting a food borne illness by not eating animal products and washing your veggies, fruits, starches and beans well.
            The devil is in the details. For those interested in blood pressures you can read a nice article on the proper technique in The Permanente Journal, Summer 2009, The Importance of Accurate Blood Pressure Measurement by Joel Handler. You can find on Pubmed. Reading this article makes you wonder if you have ever had an accurate blood pressure measurement. BP measurements should be done in quiet setting after resting for 3 minutes, with both feet on floor, no talking or active listening, proper cuff size, arm supported at heart level, back supported, with automated cuff… see article for additional discussion and consideration. The devil is in the details.




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            1. Yeah, i’ve played with blood pressure cuffs on my own. I could pretty much dial in any reading I wanted (via posture/position/attitude changes). Not sure how that applies to flash freezing.




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  3. Of note, it is felt that the parasite is not transmitted by eating sushi in the U.S. and Western Europe because typically the more expensive saltwaterfish are used. Also there are more stringent regulations in those areas on sourcing and storage of fish that are to be eaten by humans.




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    1. Good point. Many of these studies from Thailand, but the two case reports were here in North America (Mexico and San Francisco, California). I may add that many sushi joints are fairly inexpensive, as there seems to be more interest dining on raw fish in the U.S. Isn’t there even some that have revolving trays? I always wonder how long the sushi was sitting on the line before someone eats it.




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      1. As far as eating raw plants, what about the wild animals, – chickens, cattle, rabbits, horses, etc. that much on plants all day, and these plants are full of worms and bugs, insects etc. How are these outdoor animals able to deal with exposure to obviously a lot of parasites? It almost seems natural that humans once consumed a lot of raw bugs, insects, worms, when they foraged.




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  4. Have never eaten sushi and never will. But just curious: could any species of fish carry these critters or are some more likely than the others?




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    1. Good question. The studies varied from Dr. Greger’s video. Some looked at wild and farmed eel, others at freshwater fish and raw sushi. So from these studies it looks like eel, fresh water fish (areas where eating freshwater raw fish (“cebiche”) is customary), and raw sushi (all types of raw fish).




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  5. This video reminds me of my favorite scary TV show “MONSTERS INSIDE ME”….

    Not long after seeing this I visited my daughter and son-in-law in TX. He made a special dish of fish called “ceviche”. You cook the fish in lemon juice.

    I only found out later that the fish should be frozen for about 7 days to kill worms, but it doesn’t kill bacteria.

    Then after that he took us all out on his boat to doing some skiing in this very warm lake. I had to decline doing that (just went for the ride and did some safe beer drinking instead) after learning about the brain eating Amoeba Meningoencephalitis, the brain eating amoeba Naegleria fowleri that … It can cause a rare** and devastating infection of the brain called … The ameba is commonly found in warm freshwater (e.g. lakes, rivers,
    The brain-eating amoeba that killed a 9-year-old Kansas girl last week is an organism that thrives in warm fresh water.

    So bottom line, my son-in-law put us all at great risk of getting worms and an amoeba all in less than 2 days…

    Also risk of getting flute worms from eating his under boiled crawfish.

    The half-inch, oval-shaped parasitic worms at the root of the infection primarily travel from the intestine to the lungs. They also can migrate to the brain, causing severe headaches or vision problems, or under the skin, appearing as small, moving nodules.

    Some of the patients had been in and out of the hospital for months as physicians tried to diagnose their mysterious illness and treat their symptoms, which also included a buildup of fluid around the lungs and around the heart. One patient even had his gallbladder removed, to no avail.

    Also told him next time at least freeze the fish before cooking with lemon juice. The boy has got alot to learn…




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    1. correction, that should be “fluke worms”

      Flukes are flat worms. Parasitic flukes live in the intestine, tissue or in the blood. Their life cycle begins when molluscs such as snails get infected with fluke .




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  6. Hi. I am confused in general regarding fish consumption, raw or otherwise. Last week MSN posted an article from a site called Natural Health that said researchers from the University of Southern California and the National University of Singapore found that postmenopausal women who ate an average of 1.5 to 3 oz of fish or shellfish daily were 26% less likely to develop breast cancer during the 5 years of the study than those who ate less seafood. Yet Dr Greger has often cited fish consumption as a possible contributor to cancer. So which is it?




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    1. My lay opinion: “News” programming is the absolute worst place to gather any dietary information. Ever. It is not in their interest to provide answers, but to sway opinions, create confusion, distractions, angst, etc., and more “tuning in”/ratings.

      Dr. Greger appears to be genuinely interested in helping us understand the facts revealed by the research in order to make good decisions that help us, and ultimately our species survive the nutritional nightmare we have allowed to develop. I think the bulk of his work we see here represents exactly that. I trust Michael Greger to give me the facts as he diligently dredges them out of the reported research.

      I won’t always completely agree (as I’m not 100% anti-animal anything), and I think he has a bit to learn about cannabis, but I’ll TRUST the work here 100x more than ANYthing any news company will ever report. I’m not biased, I dislike them all. 8-P

      That said, from these very NutritionFacts I have come to believe that the most pervasive problem with fishes is dioxins and mercury content which can be much WORSE in “farm-raised” fish than wild-caught (contaminated feeds). There are dozens of videos here that the pescetarian (or those so inclined) should see. Cheers!




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      1. Of course, the news doesn’t have the opportunity to pick and choose which studies they report on, they report on all of them even the ones that might be wrong or only relevant in certain situations, and the “news” just reports one line from a very intense and complicated paper that cannot be summed up in one line.

        This site on the other hand, hand go through and pick and choose the studies that back up a narrow viewpoint and give vegans the opportunity to say “I told you so” to those of us who eat meat.

        In other words, this site is about as trustworthy as the “news.”




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        1. I don’t know from what well of truth you are drinking, but the “news” MOST CERTAINLY does select and chose EXACTLY which stories it runs. Otherwise it’d all be the same. (like it used to almost be, pre-internet).

          By all means eat what you want. Just try to understand the ramifications. If you are able to compile compelling arguments on the “meat” side. Please share them. I would be interested to read up.

          Yes, this site is all about “facts” that point away from meat. I’m sharp like a razor off the strop, and would love to go back. Compel me with good evidence. Thanks!




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          1. Really? You think the air head that reads the news on my local station is discriminatory on what scientific paper she reports on? No, just like everything else, they are reading, nearly word for word, a press release. And I realize that this site is about facts that point away from meat–and I am not judging the content or the motives of the site, but it does, by its own admission, have a bias for vegan and vegetarian lifestyle.

            I am going to guess that there are plenty of contradictory studies that the editors of this site decides not to mention. I am in no way trying to convince you to eat meat. I am, however, asking you to think critically and not to get your information from one source.




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            1. Yes, quite correctly, the “news” reader has no choice, but there is a layer or three of management above the bobble-head that decides what goes onto the air, which reports, which releases, which everything. It is all _very carefully_ orchestrated.

              I’ve been critically gathering information for over 30 years. Dr. MG is only one of my sources. Thanks.

              Oh and then there are the results my body gives me. Those are fairly powerful indicators of what works best for me. I actually am one of the “odd ones” here as I won’t fully renounce animal products. But I was never this healthy eating them daily. Cheers.




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    2. There is a possible problem of confounding here. People who eat fish daily are likely to eat it in place of eg red meat, processed meats or other unhealthy foods which have been liked with increased rates of breast cancer. Fish eaters are also probably more health-conscious and perhaps eat a healthier diet and have a healthier lifestyle overall . As a consequence, any association with lower risk may be due to such confounding factors.

      Alternatively, it may be linked to particular components of fish such as Omega 3 EPA/DHA (some fish oil studies have apparently shown that fish oil may be protective against certain types of breast cancer).

      However, fish can be contaminated with heavy metals (as can fish oils) which promote cancer. It’s therefore probably safer to consume omega 3/DHA/EPA from vegetarian sources. Also, the 7th Day Adventist studies appear to show that strict vegetarians (vegans) have a lower overall cancer risk than “vegetarians” who consume fish (pesco-vegetarians).
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3565018/

      In brief then, I don’t see any cancer advantage to eating fish compared to a strict, well-planned vegetarian diet. See the video of Dr Greger’s 2003 talk about the potential pitfalls of poorly planned vegetarian diets:
      https://www.youtube.com/watch?v=q7KeRwdIH04




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      1. Thank you. I just watched the video, and it seems the main criticism of fish is not that it’s so bad in and of itself but that it’s so contaminated, which is a pretty good reason not to eat it. It was good to have that doubt cleared up. Again, thanks.




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    3. It depends on what kind of research study. Can you share the link? Hard to say the benefits vs the risks of fish in regards to cancer. What we know is certain fish (and now this migrating skin worm) have loads of pollutants that have been shown to increase cancer risk. Fish contain zero fiber and very little antioxidants. There are so many videos and blogs about fish that there is reason to be concerned. Limiting or avoiding may be warranted, but of course you have to make up your own mind what’s best.




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      1. Thank you for your response. I tried looking for it–I guess it was posted on May 29–but am not computer-savvy enough to find it. I was surprised by the findings, but as Dr. Greger’s 2003 talk (shared above by Tom Goff) suggested, the results may be due to Omega 3 intake, which can be found in safer sources such as flax.




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        1. Right! If you find let me know. And keep in mind fish only have so much omega-3 fats. Sockeye salmon has almost as much saturated fat as polyunsaturated fat and 30% of it’s calories come from fat. Not such a “health food” if you break down the nutrients.




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  7. I’m vegetarian … however…what about the Japanese? Have they been overburdened with Gnathostomiasis over the last few thousands of years? I wonder if it’s to do with how food is transported, stored and prepared nowadays. There are vegetables that are dangerous to eat under certain conditions. Traditional foods tend to have protocol that come from centuries of trial and error; for example, wasabi has many protective properties, like anti-fungal ones… but it happens that most U.S. sushi bars don’t serve it. Instead they serve artificially-colored horseradish. I’m sure the way that modern mass-marketed sushi bars prepare sushi is not in keeping with these traditions.




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    1. The Japanese chefs train for approx 10 years altogether or 15 yrs if I remember correctly, including health & safety measures. Real sushi is not cheap and traditionally it was only eaten as a feast during an auspicious occasion, not bought at a cafe or a supermarket for $10 for lunch, which we now see.




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  8. Yeah, I enjoy sushi so rarely that my chances are probably significantly less than getting struck by lightning. Probably keep doing that. Wasabi and Saki to protect me! Sometimes you gotta just say “Damn the Wormpedoes, Full Speed Ahead!” Or not. Do Your Own Thing. (DYOT).




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  9. A little off topic here, but I thought it was interesting. A Texan turned vegan, now that’s big news…lol

    In case you missed Beyoncé’s big announcement this morning on Good Morning America, let us fill you in: the singer opened up about her vegan diet, The 22-Day Revolution, and revealed the meal plan is responsible for her weight loss.

    Sound familiar? That’s because it’s the same diet Bey has been promoting since February when she announced her partnership with nutritionist and exercise physiologist Marco Borges.

    “I am not naturally the thinnest. I have curves. I’m proud of my curves and I have struggled since a young age with diets and finding something that actually works, actually keeps the weight off, has been difficult for me,” Jay Z’s wife said in a clip airing this morning on GMA, which was advertised as the “first time” she’s spoken out on camera about the diet.

    http://www.eonline.com/news/664151/beyonce-facing-major-backlash-over-vegan-diet-announcement-see-what-the-beyhive-s-saying




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    1. 22 Day Diet sounds like a fad diet to me. True health and weight loss is due to a consistent healthy diet and exercise. I don’t really know about the diet itself, but there are some basic facts to a healthy life (everything else seems to be extra credit): Exercise regularly, avoid processed grains and sugars, eat mostly plants, supplement occasionally with real meats (if you’d like).




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      1. I wouldn’t call a vegan diet a “fad diet”. The reason the author calls it the 22 Day Revolution is because it takes about 21 days of doing something before it becomes a new habit.
        And now after doing it Beyonce is seeing some good healthy weight loss and general health benefits like better skin. We all know how important that is to aging women and now men.
        So now she is more likely to keep up the good results of eating cleaner and the vegan way. The diet also includes exercise.
        It is probably unlike the other “fad diets” she’s been on like millions of women are struggling with the same problem.




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  10. Oh that’s just great isn’t it ! “creeping eruptions” and “swimming in your eye balls”….
    Thankfully I gave up Sushi many years ago , and now that I’ve seen the lovely photos I’m more than happy to stick with
    avocado and cucumber sushi.




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  11. Very misleading, as all sashimi and sushi must be frozen first in the U.S.! Not dangerous and would be worth the risk if it was.




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  12. This Is Why I Refuse To Eat Sashimi (Raw Fish Or Meats Of Any Kind)….Love The California Rolls… NO RAW SEA FOODS OR OTHER Raw MEATS!!!




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  13. Dear Doctor, thank you for this video. Is there any scientific literature on parasites infection from raw fruit and veggie? (I am following a raw vegan diet..) thanx




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  14. Here in Montreal, we now have a sushi place that has a specific vegan menu, with vegan dumplings, a great selection of vegan rolls (spicy sweet potato sush maki, anyone?) made with veganaise. We take-out from them twice a month … As mentioned by another poster, no brain worm, no cruelty, no mercury, and all the taste veggies can muster …




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  15. After watching this, I am ending my consumption of Ahi Tuna or any fish for that matter. Nothing can stop my scientifically backed diet! Nothing!




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  16. I’m transitioning to a vegan life style, I know it’s healthier. Diabetis runs in the family I don’t want it.I’m insulin resistant and need to get it under-control while I can. my family isn’t very supportive of this new change but it’s for health reasons.




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    1. Kitty: It can be so hard when family is not supportive of ones choices, especially when you are doing something for your health. While you can’t get a new family, you can hopefully find a supportive group or two to hang out with. Getting moral support can make your effort so much easier. You might start seeing if you can find a vegan group in your area on the Meetup site. Or ask around at any vegetarian friendly restaurants near you.

      You are very smart to work to fix this problem before you have full blown diabetes. If you want some great tips and recipes, I recommend Dr. Neal Barnard’s Program For Reversing Diabetes.
      http://www.amazon.com/Neal-Barnards-Program-Reversing-Diabetes/dp/1594868107/ref=sr_1_1_twi_pap_1?ie=UTF8&qid=1449697963&sr=8-1&keywords=barnard+program+for+reversing+diabetes

      Good luck!




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  17. SUSHI /OUCH:https://www.facebook.com/wayne.m.diotte/posts/635174003232574

    http://naturallysavvy.com/eat/asian-food-sushi-ingredients

    Hidden Scary Sushi Ingredients Exposed SO VERY grateful for this article. We at macrobiotics.ca have been calling it [with respect to all of our Asian friends, clients and public] “Asian junk food” for many years. Tasty as it may seem definitely not recommended when trying to create good health and vitality. #toyourgreatlife




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  18. There are these extremely extremely extremely bitter herbs that we in India have to gulp down as part of aryurvedic treatments of worms. Often times in tropics, there are worms seen in poop because we roam around barefeet and apparently small children’s skin is soft and delicate enough for the worms to penetrate thru’ foot (or at least thats what we were told by our parents maybe to encourage us to wear footwear before roaming around in outside)
    The potions were so bad tasting and bitter (all natural herbal ) that I am sure it would nearly kill anything crawling around in the system.




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  19. Hello there,

    Where I live fish always comes to the store frozen.. the most common argument I hear is that this (and other worms) can’t effect us because they are ‘killed’ from freezing. Is there any truth to this or can you have a reaction of some kind to worms in fish, frozen or not?




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