I had to write this, although I would rather not.
The knowledge that it could potentially help so many people in the same way that it has done for me weighs heavily on my mind. It creates a moral obligation to disseminate what I have found and allow people the option of acting on information that has taken me years of searching to discover…
What if I told you that you are missing a few strands of very useful DNA.
DNA that if added back to your natural biome could affect all kinds of changes to your physiology.
DNA that has been present for hundreds of thousands of years. Until recently, when we took steps to eradicate it.
As always, action and consequence are inseparable.
Helminthic therapy, or self infection with one of a select few species of parasitic worms, is a controversial topic.
With good reason. Hookworms are a leading cause of disease in the developing world with around 750 million people suffering from infection, which can cause anaemia, growth retardation and malnutrition in heavily infested populations. Hookworms can even be lethal, with hookworm related death standing at an estimated 60,000 people per year (Crompton 2002, de Silva 2003).
In first world nations, cleanliness, sanitation and clothing measures have eradicated hookworm infections by breaking their life cycle. (Brooker 2004, Crompton 2000)
This may seem like a good thing at a casual glance. The economic impact of hookworms is huge for some countries. For example, productivity losses due to hookworm infections in South Asia have been estimated at a value of approximately 5 billion dollars annually. (Crompton 2002) At first glance, exterminating these parasites seems wholly sensible.
There is a caveat however, to throwing nature out of balance by Man’s crude intervention. By vastly overpopulating areas in developing countries, we have created the perfect conditions for huge hookworm burdens. Then, by removing hookworms completely, we induce conditions unnaturally sterile. Our bodies, finely tuned through eons of evolution to respond to the challenge of parasite infection, react erratically.
Westernised nations have witnessed a dramatic rise in the incidence of chronic inflammatory and autoimmune diseases, a rise that is concurrent with hookworm eradication. Researchers soon realised that many autoimmune diseases are largely absent in Third World populations. This discovery gave rise to the Hygiene Hypothesis.
The Hygiene Hypothesis theorises that the absence of various micro-organisms in Western society causes dysfunction in immunoregulation (Stiemsma 2015, Versini 2015). We see this manifest itself in diseases such as MS, Crohns disease, Asthma, and Rheumatoid Arthritis. This theory can be traced back to the 1870s when it was noted that aristocrats and city dwellers were more likely to get hay fever than farmers.
This idea was further developed into the ‘Old Friends Hypothesis’.
Whilst it would be rash to state that the sole cause for the increase in autoimmune diseases seen in our society is due to helminth eradication, it is certain that the underlying cause in genetically susceptible individuals is environmental. One of these environmental factors is the removal of Helminths, or ‘old friends’ (Rook 2012).
In Rooks’ words:
“The Old Friends hypothesis suggests that one reason for the increasing incidence of chronic inflammatory disorders in developed countries since the mid-nineteenth century is the depletion from the urban environment of organisms that accompanied mammalian evolution and had to be tolerated. In parts of the world where there was a heavy load of organisms causing immunoregulation (such as helminths), there has been selection for single nucleotide polymorphisms (SNP) or other gene variants that partially compensate for the immunoregulation. As soon as immunoregulation inducing organisms (Old Friends) are withdrawn by the modern lifestyle, the genetic variants lead to excessive inflammation, and become risk factors for chronic inflammatory disorders”
In effect, organisms like helminths have been present in the human environment since the evolution of our species. Our immune systems have been titrated to their presence. Further, genes have evolved to help to manage the burden of these organisms, genes which predispose individuals to autoimmune disease once the helminths have been removed.
At this point it seems pertinent to introduce one of these ‘Old Friends’.
Enter the hookworm, Necator Americanus, (NA)
Necator=Killer, Americanus=American (Caucasians usually have less tolerance to NA than other ethnicities, hence its name).
There are other species suitable for Helminthic Therapy, but this creature is so adapted to living with humans it is considered by many to be a symbiont rather than a parasite. In sensible doses, it appears to offer several benefits to its host (the human) and in return, it gets the opportunity to proliferate and ensure the survival of its own species.
This does not make pretty reading, but life is life and making a living as a parasite, even a relatively symbiotic one, is not for the squeamish.
NA start life as eggs passed out in faeces of an infected individual. In the right conditions (28-32 degrees and humid) they hatch within 48 hours into first stage larvae and moult again into third stage larvae by 5-7 days. They now migrate to the soil surface or cluster in moisture droplets on ground flora. Should they get into direct contact with a human, often through contact with bare feet on infected soil, they penetrate the skin into blood vessels and are swept up by the circulating blood to make a quite remarkable journey.
The larvae travel through the heart and penetrate into the lungs, where, powered by their fat stores they crawl up to the pharynx and are swallowed down into the digestive tract. Once at the jejunum of the intestines, some 3-7 days after first infection, they begin to suck blood from their host. On average, a mature NA wil harvest approximately 0.03ml of blood per day from a host. By 4-6 weeks and at approx. 1cm long they reach maturity and females begin egg production, at which point, the cycle is complete (see Fig. 1).
Fig 1. Life Cycle of Necator Americanus (Hotez 2004)
Importantly, NA cannot proliferate without eggs exiting the body and maturing in the right conditions. Hence it is easy to see how simple sanitation breaks their life cycle. Further more, I cannot find any reference of this species migrating to the wrong tissue. They solely parasite with humans, and are highly efficient in the business of getting into your guts. As such, their dose is controllable, a colony can be effectively eradicated with simple medication, and in sensible numbers they are well tolerated. At a dose of 25-30 NA, once established, they are largely asymptomatic. In doses of 100-500 worms, damage to the intestine is considerable, while doses of 1000 worms may be lethal (Mehlhorn 2015).
Fig 2. The business end of NA, noting two cutting plates on the buccal capsule which allow the adult to feed. (from Hotez 2004)
Fig 3. Adult NA feeding (from Hotez 2004)
This is all very interesting, and I am sure for some, a rather unpleasant thought. But surely no-one in their right mind is going to infect themselves with these creatures to see if some scientists hunch about ‘Old Friends’ is correct!?
Well, they have, and they do today in the thousands (Cheng 2015). It is just not a topic that is often broached over the canapes at dinner parties.
Starting with a handful of forward thinking, pioneering mavericks, with special mention to Prof Pritchard of Nottingham University, who allegedly infected himself with 50 NA larvae in order to get ethical approval to start human trials (Svoboda 2008). All the way up to companies (who shall remain nameless) that offer affordable NA larvae for sale online. There are patients desperate for an efficacious treatment when modern medicine has failed them.
When you are faced with a problem you cannot solve with conventional techniques, you need to disregard convention.
Which is where my own story began.
Suddenly, at age 30, the very mild and intermittent psoriasis that had occasionally presented itself on my skin, literally exploded. It coincided with a new and very stressful job, pressures at home, less chance to exercise and most definitely less sleep.
The visible skin lesions were the least of my problems. A once bullishly confident mentality spiralled into anxiety and self doubt, by iron gut developed intolerances for pretty much everything I ate, and I awoke most mornings to the feeling of mild flu-like symptoms. The gluten in a pint of lager or a sandwich would set my skin burning for hours afterwards, and without going into too much details, my bowels decided to wring themselves out every couple of hours.
Finally, I dragged my carcass, some 20lbs lighter than my usual fighting weight, to the doctor. A ‘specialist’ I might add in dermatology.
“Love to cure this” he scoffed after a 10 minute monologue on the epidemiology of Guttate Psoriasis.
“But I can’t. There is nothing you can do but keep using the steroids.”
Reaching back into my biology background, I suggested that since I had spent 30 years pretty much free of any problems, there MUST be some epigenetic mechanism for my current predicament.
This was bordering on dissent, and with a scowl of his ridiculously bushy eyebrows, I was dismissed from his office.
Finally, after paying to see a real dermatologist, I was referred to a local dermatology consultant. By now I had come up with a protocol of diet, fasting, various supplements, UVB exposure, steroid use, heat therapy and cold thermogenesis that reduced my symptoms maybe by 50%. At least I wasn’t bleeding into the bed covers overnight and I had control over my mind-set once again.
I was offered Methotrexate, and I thought I had finally exacted some semblance of control over my aberrant immune system. Not so, we had to keep increasing the dose to maintain the effect. Realising this strategy was unsustainable, and suffering the side effects of systemic drug use, I redoubled my efforts to find another solution.
Then, one day, a chance comment from a medical doctor about some research being conducted in Nottingham set my mind on fire. They were conducting a trial on Multiple Sclerosis patients, using hookworms to attempt to induce remission.
Hookworms make intuitive sense for someone who likes to view the world through an evolutionary lens. Although the mechanisms through which Helminths can regulate our immune systems are still being teased apart (Elliot 2012, Bashi 2014) it didn’t matter to me. I just needed to be sure they might alleviate my symptoms, and that they were safe.
A few short weeks and a lot of reading later, I sat at home, looking, with serious trepidation, at a small vial filled with clear liquid.
Inside it, were 25 stage L3 NA Larvae, purchased online with laboratory assurance that they were as sterile as a multicellular organism that comes from faeces can be.
Now I am not by nature someone who puts off what needs to be done. But I won’t lie when I say it took a few minutes of serious contemplation before I pipetted the innocent looking fluid onto the supplied dressing, and pressed it onto the skin of my inner arm.
Would this work? Did the larvae survive transit? Would they find their way onto my skin?
I needn’t have worried, less than two minutes after application, it felt like dozens of hot needles were boring into my skin. This was very real, and now there was no going back. They were inside me.
My body went totally mental.
I didn’t sleep that night such was the itching on my arm, and I got a low grade fever the next day that lasted 48 hours.
Exactly 5 days post inoculation, I awoke in the middle of the night thinking someone was choking me. My throat was burning and closing up fast, causing my breath to rasp in my chest. As I sat in the bathroom gasping for breath, I knew exactly what was happening. They had made it to my throat and were about to finish their migration down into my intestines.
10 days after inoculation, I awoke once again in the early hours of the morning to terrible stomach ache. My regular regimen of intermittent fasting was out, the only remedy for this was a large breakfast, which for reasons unbeknownst to me helped ease the symptoms. My skin, likely because I had stopped the Methotrexate, worsened.
Bereft that I might have to drag my arse back to the Dermatologist and actually ask her for worming tablets, I toughed it out.
Pic 1: Day 0, prior to Hookworm Inoculation, ceased Methotrexate
Suddenly 3 months post inoculation, I realised I hadn’t had gut ache for a few days.
By 6 months, my skin started to heal.
By 9 months I realised I could eat and drink a ‘normal’ diet with only minimal flare ups of my skin symptoms.
The picture taken at 10 months post inoculation make clear the extent of remission I continue to experience from a single dose of these remarkable creatures. It is now time to try adding another dose and see how I tolerate them and if it will further benefit me.
Pic 2: 10 Months Post Hookworm Inoculation, no systemic drugs
Coincidence? I don’t think so, my Psoriasis had been gradually worsening then stable and resistant to treatment for around 5 years prior to this.
It is useful to put this single experience in the context of the bigger problem facing the medical community.
Over 23.5 Million Americans are afflicted with Autoimmune disease, which is also in the top ten causes of death for women younger than 65 years of age (Elliot 2012). This pattern is repeated throughout other westernised cultures, and incidence of diseases such as Crohn’s and Ulcerative Colitis continue to surge.
In short, everyone will know of someone battling with an autoimmune disease that is potentially ‘incurable’. Once your immune system learns to attack your own tissues, it never forgets.
It may seem like self-treatment with a known human parasite is a cavalier approach taken by people desperate for a solution to their illness. In actual fact, there is a wealth of evidence that continues to build in favour of using helminths as an efficacious treatment for autoimmune and inflammatory disease (Weinstock 2013, Wammes 2014, Helmby 2015, Maizels 2016, Parker 2016, too many more to list, see http://helminthictherapywiki.org/wiki/index.php/Helminthic_therapy_research for a collection of the literature). It is just unfortunate that adequately powered human trials are sparse. Sadly, on the merry-go-round of funding for clinical trials, no-one makes money from a hookworm unless they can patent it. To do that, you need to synthesise the molecules it produces which modulate the immune system, put a fancy pharmaceutical name on it, and charge a small fortune for its use. Why else would the FDA label hookworms a medical device? Yes, if you want to get some NA larvae in the US, you’ll be crossing the border into Mexico.
So how are Helminths able to affect such change on our immune systems?
Whilst not completely understood, there seems to be several mechanisms that cause immune modulation.
· Improvement of intestinal barrier/mucosal layer (Wolff 2012, Sipahi 2017)
· Beneficial improvement in gut microbiota (Parker 2016, Jenkins 2017)
· Shift of the immune system response from a Th1 to a Th2 response (Bashi 2014, Fallon 2007, Mulcachy 2004)
· Secretion of immune modulating compounds that allow Helminths to evade the immune system and reduce inflammation (Chow 2000, Smallwood 2017)
As an aside, for anyone interested in ‘leaky gut syndrome’, or its link with autoimmune disorders, this paper (Fasano 2012) is a great place to start reading.
What does the future hold for this form of therapy?
It has genuinely changed my life, but not everybody will be willing to infect themselves with a known human pathogen, no matter how desperate they are for useful treatment options.
Furthermore, it is unlikely that the medical community will make Helminthic therapy standard practice any time soon. The jump to prescribing hookworm larvae to patients is a huge shift in practice, even if randomised control trials in human populations eventually show definite benefits over standard treatments.
For now, the best option for any interested, prospective patient, is to firstly assume ultimate responsibility for their own health.
No matter how proactive and empathetic your physician may be, your health is your responsibility. Only by fully arming yourself with the information needed to provide you with a clear course of action, will you have the empowerment of foresight.
No-one can guide you to take this course of action, nor should they. It is a decision you must make yourself, after deep deliberation of the facts.
Helminthic therapy may help a plethora of conditions, using either Necator americanus, or Whipworm, usually administered as pig whipworm (Trichuria suit) ova which only persist in the human body for a few weeks.
Personally, I would no longer be without these Old Friends. And not just for reasons of autoimmunity.
Through the excellent and thought provoking work of P.D Mangan published at Rogue Health and Fitness, I have recently been made aware of the role of iron in aging and chronic disease. ‘Ferrotoxic’ disease is briefly surmised as the range of conditions for which body iron burden is a contributing factor, and is increasingly being linked to a host of the usual chronic diseases such as malignancies, endocrine disorders and cardiovascular disease. (Zacharski 2014)
A number of striking points come to mind upon reading about the issues of increased iron burden. Firstly, the body has no means of removing excess iron, instead storing it as ferritin.
Why would the body not evolve a mechanism through which to remove excess iron, given how reactive and potentially damaging the molecule can be?
Well, it never had to. There were always parasites gradually removing it through blood loss. Helminths are well documented to cause anaemia if the parasite burden gets too high (Crompton 1993) and as we have seen, helminths are consistently prevalent in humans without access to modern sanitation. A situation that was the norm from our evolutionary conception up until a few generations ago. Consider this. Each NA harvests around 0.03ml +/- 0.015ml of blood per day from its host. Even a mild NA infection of 100 worms will remove 3-4 mls of blood per day, over a litre of blood per year, causing an iron loss of around 675mg per year.
Is it possible the removal of Helminths from our natural biome is leading to a potentially detrimental increase in ‘normal’ iron levels?
Along with many other questions surrounding Helminth infection, this is something I would implore researchers to investigate.
For now, it is clear that Helminthic therapy offers a potentially cheap and highly effective treatment option for various autoimmune diseases. Furthermore, moderate Helminth infection and its anti-inflammatory components may have additional benefits in conditions like depression and cardiovascular disease (Raison 2010, Abdoli 2017).
Maybe one day in the future, people will infect themselves, or their children with hookworms, in the knowledge it will help to protect them from a variety of ills.
Such has been the co-evolution between us, I believe this is plausible. The more you examine the relationship, the more it seems mutually symbiotic.
For now, people are restricted to sourcing these organisms, this missing DNA, in a cloak of secrecy with often little or no backing from their medical professionals.
This must change, and medical science must step up to the mark and examine Helminthic therapy in the cold light of logic. Not be swayed by misinformation, emotive opinion or profit driven pharma dollars.
If it is truly, as I have personally found it to be, an efficacious treatment, then it is the right of every patient to have Helminthic Therapy open to them as an option.
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