Helminthic therapy is an experimental approach to the treatment of asthma, allergies and inflammatory and autoimmune diseases, which involves the administration of controlled quantities of selected, benign intestinal parasites such as hookworm and whipworm.
The treatment developed out of understanding gained from scientific studies which showed that, while these illnesses have escalated in developed countries during the past 50-100 years, they remain much less common in parts of the world where intestinal parasites are still prevalent.
The aim of the treatment is to rebalance the host's immune system by replacing one or more of the harmless organisms which have been lost in recent decades due to improved hygiene, sanitation and lifestyle changes.
The organisms used have become masters of the human immune system during millions of years of coexistence with man and are adept at regulating their host's immune response. In fact, the codependent relationship between worm and man is so close that the human genome is now arguably incomplete without the genes contributed by these organisms.
Helminthic therapy has already been, or is currently being studied as a treatment for a number of diseases including allergies, asthma, diabetes (type 1), ulcerative colitis, Crohn's disease, and multiple sclerosis, and the results from the completed trials are impressive.
There are anecdotal reports and/or theoretical reasons to suggest that a number of other conditions may also respond well to helminthic therapy, including arthritis, atherosclerosis, autism, coeliac disease, dyspepsia (non-ulcer), eczema, depression, fibromyalgia, heart disease, irritable bowel syndrome, lupus, migraine, psoriasis, psychiatric disorders and rheumatoid arthritis.
All that current medical practice can offer to those who have the above conditions is drug therapy, which, apart from offering variable and sometimes only limited success, often produces side effects ranging from unpleasant to very serious. Controlled doses of helminths, on the other hand, cause no lasting side effects.
In spite of the compelling nature of the evidence already gathered in favour of helminthic therapy, it is not yet generally available in the UK on the NHS for any condition. However, if a patient can interest their specialist in this treatment and persuade him or her to support them in trying it, that specialist might be willing to refer the patient for treatment at Nottingham, where hookworm larvae are available. In theory, all that is required in order to access this resource is a doctor who is willing to take responsibility for the treatment.
Where a specialist is reluctant to do this, it is likely to be due to the fact that the treatment is still considered to be experimental. This situation may be overcome if the patient provides a written note accepting full responsibility for any adverse outcome from the treatment, although, in fact, none is likely.
Alternatively, if a patient can afford to pay for treatment, they can join the growing number of pioneering individuals who are sourcing helminths from one of the companies that have begun to offer them for sale, and use these organisms to treat themselves.
Hygiene: a two-edged sword
Since the role of bacteria in disease was discovered 150 years ago, many of the infectious diseases which had hitherto plagued mankind, such as cholera and diphtheria, have been eradicated from the world's industrialised nations by improved hygiene and sanitation. However, around 60 years ago, chronic diseases began to take their place as the major cause of disability and death.
Isolated studies carried out during the hygiene era, had pointed to a connection between a lack of exposure to infectious agents during early childhood and susceptibility to allergic diseases, but it was only in the late nineteen eighties that this theory began to be taken seriously and the 'hygiene hypothesis' was conceived.
This hypothesis focused attention on the need of infectious agents to prime the immune system, but the theory was subsequently shown to be incomplete, and a new 'old friends hypothesis' was put forward, emphasising the need for exposure not just to bacteria but to a range of organisms with which our species has coexisted throughout much of its evolutionary history, notably harmless microorganisms from soil, untreated water and fermenting vegetable matter and, critically, parasitic worms.
In our preoccupation with hygiene during the twentieth century, we inadvertently ostracised these 'old friends' and, in so doing, subverted immune regulating mechanisms which had taken millions of years to develop and refine, inviting, in their absence, the slew of chronic diseases involving inflammation and auto-immunity that are rife today.
Fortunately, we are now beginning to realise this mistake and, thanks to our hygiene experiment, we have acquired knowledge which we can now use to encourage beneficial organisms at the same time as avoiding the harmful ones. In fact, we are now very well placed to strike the ideal balance between the two, and helminthic therapy has a pivotal role to play in this process.
Reintroducing old friends
In order to reap the health benefits which our 'old friends' can provide, we need to overcome our tendency to view all 'foreign' organisms in a negative light. The gross-out, or yuck factor in respect of 'bugs' is so powerful and prevalent at the present time, that, in spite of the large numbers of people suffering significant distress from Crohn's disease, it has taken the researchers at Nottingham University three years to recruit just 52 candidates for its hookworm study, compared with the 1,500 who recently volunteered during a single day to take part in a trial to assess how flavonoids, found naturally in chocolate, could fend off heart disease! And most of those who have obtained helminths for self-treatment prefer not to tell anyone about this, including, in a significant number of cases, their own spouses!
The commercial sector has spent decades encouraging us to fear and loathe bugs of all types, in order to increase sales of their antimicrobial products, and media coverage of epidemics and incidents involving 'superbugs' do little to enamour us to microorganisms, but this conditioning must be overcome if we are to regain the benefits which our 'old friends' have to offer.
Ideally, exposure to our 'old friends' should begin during infancy, when the immune system is developing, but some organisms can still bring immune/inflammatory responses back into balance when they are re-introduced later in life.
When bacteria from the intestines of healthy donors were transplanted, via enemas, into the colons of six patients with severe chronic ulcerative colitis, patients' symptoms were completely reversed in four months, in spite of ceasing all other medications for the condition,
and there was no recurrence of symptoms during a thirteen year follow-up period. Click for details. However, there is currently no convenient way to receive faecal bacteriotherapy, and this form of treatment is rarely employed.
The oral administration of particular strains of probiotic bacteria is gradually becoming an established practice, and research continues to reveal benefits for this form of therapy, but there is a daunting number of different strains of probiotic bacteria to be investigated and this branch of science is still in its infancy.
Helminthic therapy, however, offers a simple, convenient and ready-made source of relief for a number of chronic conditions, with success rates, as measured by the number of patients achieving remission, at least equal to and, in many cases, higher than those recorded for immune-modulating and anti-inflammatory drugs.
Two particular helminths which have been, and are still being used in research, and are also available from commercial outlets, are the human hookworm Necator americanus and the pig whipworm Trichuris suis. One supplier is also now offering a third organism - the human whipworm (Trichuris trichiura).
All three worms share a number of advantages, namely that none of them causes any disease in man at therapeutic doses, nor is able to reproduce within a host, or pass easily from one person to another. All are compatible with conventional medical treatments and are easily eradicated, if this should be required.
Hookworms survive for an average of five years, human whipworms for approximately two years and pig whipworms for 2-3 weeks, the relative longevity of hookworm and human whipworm making them much more cost-effective than the pig whipworm.
Inoculation with hookworm is achieved by a single application to the skin of 25-35 microscopic larvae. These are available from Autoimmune Therapies at a cost of $2,900.00.
Side effects from inoculation with this number of hookworms are transient, if present at all, and can include a rash at the inoculation site, possibly followed by gastrointestinal symptoms and fatigue in some individuals during the following 1–4 weeks. As hookworm feed on their host's blood, anaemia can develop in individuals who host extremely large numbers of this organism. However, 35 hookworms only take a total of one teaspoonful (5 ml) of blood per month, so the risk of anaemia at this dose is insignificant.
Pig whipworm ova (TSO), available from Ovamed, are taken orally in a drink, and patients normally start with four separate doses of 500 ova, taken every one to three weeks. If there is no reduction in symptoms on this regimen, the dose is increased to 1000 ova per dose, up to a maximum of 2500 ova per dose every two weeks, which is the dose most frequently required, at a cost of $400.00 per dose.
There have been occasional reports of allergic reactions to whipworm but, compared with the side effects experienced by patients taking conventional immune-modulating or anti-inflammatory drugs, the side effects of whipworm are negligible.
Human whipworm ova (TTO) are similar to TSO but, because they are adapted to humans, they do not die off as quickly as pig whipworms. They are available from Autoimmune Therapies at a cost of $2,900.00 for a dose which will last approximately two years.
The evidence suggests that whipworm and hookworm produce similar beneficial results in all conditions except ulcerative colitis, which seems to respond even better to whipworm.
It is possible that hosting more than one species of worm at the same time may provide increased benefit, as multiple helminth species appear to promote stronger immunological regulation. However, as yet, there are few individuals hosting more than one type of worm for therapeutic purposes, so feed-back is limited. Combination therapy (hookworm plus human whipworm) is available from Autoimmune Therapies for $3,900.00
The future for helminthic therapy
In order for more people to be able to benefit from helminthic therapy, there is an urgent need for a reduction in the cost of commercially produced worms and, ideally, for them to be available in the UK on the NHS.
The price of hookworm larvae from Autoimmune Therapies has recently been reduced significantly, and the cost of both larvae and ova will hopefully reduce still further with greater demand, but it is likely to be some time yet before this picks up to any great extent, in view of the generally negative attitude towards worms of both patients and doctors.
The treatment is not likely to become widely available on the NHS until sufficient research has been completed for it to lose its experimental status, although reading between the lines of the press release for the latest Nottingham trial, one gets the impression that, if the study was to demonstrate the treatment's effectiveness for MS, the medics involved may then employ this treatment, which is described as simple, natural and controllable, for the wider benefit of MS patients generally. This may then become a precedent for the use of worms in the treatment of other conditions.
Who knows where this development may eventually lead? We might perhaps one day see children given their first dose of helminths in infancy, particularly those with the highest risk of developing allergies, and those whose genetic profiles indicate the likely development of autoimmune or inflammatory disease later in life.
It is already apparent that helminthic therapy has huge potential to improve the health of millions of people worldwide and to transform the practice of medicine, but, in order to benefit from it, we must first re-embrace the idea of coexistence with those companion organisms which have for so long shared our evolutionary journey and, without which, we are no longer complete.
For an explanation of the theoretical framework supporting helminthic therapy - www.hygienehypothesis.com
For an explanation of helminthic therapy and a large collection of some very good research papers - www.helminthictherapy.com
For an article detailing one patient's experience of the Hookworm in Crohn's Disease trial at Nottingham.
For information on the use of helminthic therapy with specific diseases, go to www.ncbi.nlm.nih.gov/pubmed and enter "helminth" plus the name of the disease you're interested in.
For the latest research relating to the worms and bugs that keep us well, check out the Gut Buddies blog.
For up-to-the-minute discussion on all matters helminthic, visit the Yahoo helminthic therapy forum. Registration required; not moderated. Click on the Files link on the left for dozens of good research papers.
For discussion about TSO, visit the Ovamed forum. Registration required; moderated.
Click here for more articles on helminthic therapies
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