The Benefits of Worm Therapy
In many developed countries, the fear of contracting disease has made helminths (large macroparasites), bacteria, and viruses target for total eradication. As a result, there has been an increase in the production and use of antibacterial soaps, antibiotics, vaccines, and antiparasitic drugs; all in effort to prevent an infection from all bugs and germs living in our environment.
In addition, in high income or developed countries where helminth (parasite) infection is not a public health concern, there is a steady increase in the prevalence of autoimmune and allergic diseases compared to previous years (1). However, in countries where good health standards are less available, particularly in rural communities and developing countries, the number of people living with parasites is much higher. The interesting thing to note is that they may experience infections more often, and have parasites living within them, but in turn the rates of allergic and autoimmune conditions are dramatically lower.
So, this leaves us with the question, are helminths (worms) beneficial? Can worm therapy help to lower the incidence of autoimmune and allergic diseases in developed or high-income countries? Read on to learn more.
What Are Helminths?
The first thing that usually enters into a person’s mind when they think of worms is that worms are squirmy, gross, ugly, wiggly little parasites that cause harm. But in reality, there are many different species of worms. And while they may all possess the squirmy, gross, ugly wiggly characteristics, not all of them cause harm to their host. So basically, not all worms are parasitic.
A helminth is a large multicellular organism that can belong to the phyla of roundworms (nematodes), flatworms (platyhelminths), tapeworms (cestodes), or flukes (trematodes). It is also considered to be the most predominant multi-cellular animal on planet. It may come as a surprise, but among the thousands of helminths out there, most of them are not parasitic. In other words, they do not cause harm to their host. In the past, it was normal for some helminths to live as part of the intestinal flora (microbiome) in the human gut. Today, they are finding their way back, and many physicians and scientists are studying their use in the treatment of many chronic and debilitating conditions (2).
The difference between mutualism, commensalism, and parasitism
In order to better understand the role that helminths are playing in medicine today, it would be helpful to explain the different relationships bacteria, viruses, and helminths can have with their human host.
Parasitism: As previously mentioned, this is the relationship most people think of when they think of helminths. In this relationship, one species (the parasite) benefits from the relationship, while the other species (the human host) is harmed. So of course it makes sense to want to eradicate the parasite if it is causing harm.
Commensalism: In this relationship, one species benefits while the other species is not harmed. Did you know that all humans carry around microscopic mites (bugs) on their skin that live within hair follicles and oil secreting glands? This is an example of a commensal relationship between these mites and humans. We don’t benefit from the relationship, but we are also not harmed by it either.
Mutualism: Mutualism is usually a relationship between two different species, working together for the benefit of both organisms. Another impressive thing about this relationship is that both organisms will evolve together. As one becomes part of the other’s environment, it has to adapt to the new environment. This type of interaction is what some scientists and physicians believe to be missing in developed and overly sanitized countries. If a helminth has the potential to provide benefit to our health, then what are the consequences of us no longer being exposed to them?
The Need For Worm Therapy
As previously mentioned, there has been a dramatic rise in the incidence of autoimmune diseases in developed countries, and especially in America. We have gotten so good at fending off “germs” and parasites, that we have almost put America into a hypothetical bubble. You may be thinking this is a good thing, but have you ever heard of the story of the boy in the bubble? His immune system was so weak that he had to live in a bubble for survival. Any exposure to the outside environment would have killed him.
Scientists have also recreated this model many times with mice. Mice that have their microbiome removed are literally unable to survive. All this does is further support the belief that the reduction of bacteria, viruses, and worms in our environment is contributing to the sustained growth of allergies and autoimmune diseases. This includes conditions like Crohn’s disease, ulcerative colitis, Type 1 diabetes, asthma, allergic dermatitis, seasonal allergies, multiple sclerosis, psoriasis, celiac disease, and many more.
Incase you aren’t familiar; an autoimmune disease refers to a condition in which the body’s immune system mistakenly attacks itself. In this case, the immune system may view certain parts of the body, such as the skin, joints, organs, or any other part as foreign, and then attack it. During this attack, the immune system releases a form of protein referred to as an autoantibody, which can cause severe damage to healthy cells in the body.
An analogy commonly used by some people is that “an idle mind is the devil’s workshop.” The idea is that an immune system that is left idle can become a misdirected one. So, we humans need to have helminths and bacteria living on us and inside of us in order to keep the immune system active.
The Science Behind Worm Therapy
The idea behind the use of helminths in the treatment of disease is that helminths and our immune system have evolved together, and this relationship is millions of years old. As a result, helminths have now become efficient modulators of the immune system in order to ensure their survival. This modulation of the immune system can alter or even suppress certain immune responses, which could be of great benefit to the host. Such actions can even help to control excessive inflammatory responses in humans, which is especially exciting considering most autoimmune conditions are associated with excess inflammation.
Inflammatory Bowel Disease (IBD)
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the intestines. It is broken up into two conditions called Crohn’s disease (CD) and ulcerative colitis (UC). In these conditions, there is dysregulation of the immune function of the mucosa in the digestive tract. This results in impairment to the mucosal barrier, and leaky gut occurs. Once foreign substances are allowed to leak through the intestines into the blood stream, a state of chronic inflammation begins. As of 2015 over 3 million Americans were diagnosed with IBD, and it is believed that many more unknowingly suffer from this condition as well (3).
To date there have been multiple clinical trials conducted on helminth therapy and IBD. In 2003, 4 patients with CD and 3 patients with UC were given one round of pig whipworm ova and then monitored for 12 weeks. For the first 8 weeks following the therapy, all of the patients experience significant improvements in their symptoms. At 12 weeks, 3 patients relapsed back to their previous state. This suggested the possible need for repeated dosing, so they went on to give additional doses every 3 weeks for 30 weeks. During this time all patients experienced continued improvement and no adverse effects (2).
The problem with pig whipworm therapy is that humans are not the natural host for this worm, and therefore repeated dosing is required in order to maintain an ongoing infection. This infectious state is where the magical immune modulation takes place, so it would be ideal to have it last as long as possible. This led scientists to look into human hookworms. Hookworms have adapted to survive in humans and establish a chronic infection that can last for years after a single inoculation (2).
In 2006, a group of patients with CD were inoculated with 25 or 50 live hookworm larvae. It took a while for results to be seen, but after 20 weeks all patients showed significant improvements, and after 45 weeks, five patients were in full remission. That is pretty spectacular considering modern medicine currently has no cure for IBD (2).
Multiple Sclerosis (MS)
Multiple sclerosis (MS) is a degenerative disease of the nervous system. It results in severe impairment to vision, coordination, and movement, and eventually results in paralysis. With MS, there is dysregulation in the immune system and the immune system attacks the myelin sheath that covers the nerves. Nearly 1 million Americans suffer from MS today, and about 200 new cases are diagnosed each week (4).
In 2007, a group of patients with MS were split into either a placebo group or treatment group. The treatment group was inoculated with hookworms and were monitored and followed for five years. At the end, the group infected with hookworms showed a significantly slower progression of their disease and fewer side effects than the placebo group (2).
Celiac disease is an autoimmune disease that occurs in genetically predisposed individuals. When these individuals consume gluten, their immune system starts to attack their small intestine. These attacks lead to damage in the digestive tract, and make it difficult to properly digest and absorb nutrients. It is estimated that 1 in 100 people worldwide may suffer from celiac disease with most of them being unaware of it (5).
There have only been a couple of trials conducted on helminth therapy and celiac disease. One trial did two doses of 15 hookworms followed by an overly aggressive oral gluten challenge, which showed no positive effects. The 2nd trial used 20 hookworms in combination with slow gluten desensitization. Over a long period of time they would introduce micro doses of gluten to the celiac patients while they were infected with the hookworms. At the end of the trial, all patients were tolerating oral gluten intake with no adverse effects (2).
This may never result in celiac patients being able to live a normal life with the regular consumption of gluten, but it could make life much easier by eliminating the need to worry about cross reactivity and gluten contamination.
Meet The Worms
Currently, there are four types of worms used in helminth therapy. These worms have been chosen due to there being a much lower risk of serious infection. Most of the side effects experienced from worm therapy tend to be mild in nature and may include itching at the site of inoculation, abdominal cramps, nausea, vomiting, diarrhea, anxiety, fatigue, and a low-grade fever. Usually the side effects are short lived (6).
Pig whipworm – Trichuris suis ova (TSO)
The TSO therapy comprises of purified eggs extracted from the feces of pigs, which happens to be the primary host. The single-cell eggs are initially taken from an infected animal, purified and used for treatment. Since humans aren’t their natural host, long-term infections are very rare. This means that the lifecycle inside of a human is only 2-3 weeks.
Rat Tapeworm – Hymenolepis diminuta cysticercoids (HDC)
The rat tapeworm is another type of worm deployed in helminth therapy to treat diverse ailments. The worm is frequently seen in rodents, but infrequently in humans. It grows in grain beetles, which were commonly found in our food supply until 100 years ago. This worm is found inhabiting many people in developing countries and shows little to no adverse symptoms. This is why it really can’t be classified as a parasite. This worm also lives in the human host for only 2-3 weeks.
Human whipworm – Trichuris trichiura ova (TTO)
Unlike Trichuris suis (pig whipworm), the Trichuris trichiura (human whipworm) is extracted from human feces. The worm can also live in a human host for up to five years. This is more beneficial from a therapeutic standpoint, because it means positive results can be seen for longer periods of time without the need for repeated inoculations. There are approximately 800 million people worldwide who host TTO currently with little to no adverse effects.
Human Hookworm – Necator americanus (NA)
The Necator americanus, a.k.a the human hookworm, is another type of worm obtained from human feces and purified for safe use. For therapeutic purposes the eggs are placed on a bandage, which is then placed on the skin of the patient. The eggs hatch and burrow their way into the bloodstream where they make their way to the lungs, get coughed up, swallowed, and then find residence in the digestive tract. Similarly to the human whipworm, NA can live in the human host for up to five years.
There is still so much that we don’t know about using worms for therapy. Not all worms are safe for humans, and not all humans respond the same way to worm therapy. The FDA has strong restrictions on therapeutic worms being imported into the United States and used for treatment purposes. Anyone interested in experiencing worm therapy will have to seek out a clinical trial, or visit one of the clinics that offer this therapy in Mexico or the United Kingdom.
Some research is being conducted to extract the portion of the worm that interacts with the human host and put it into pill form in order to eliminate the consequence of infection. I tend to believe that nature is smarter than we are, and that only in its whole natural form can the real magic happen.
If you have followed most of my blogs or social posts, then you know I am a firm believer in microbiome restoration. In my opinion, true health comes when we live harmoniously with nature. In order to do this, our bodies must represent a diverse ecosystem not unlike the many ecosystems found on the planet. In nature there is an abundance of mutualistic and commensal relationships that are a normal part of balanced living. Humans are the only species that refuse to live in harmony with nature, and I believe this has resulted in detrimental effects to our overall health.
As I always say, spend more time outdoors. Get your hands in some rich soil. Let your kids get dirty, and when you clean them up, use basic soap not antibacterial soap. Don’t be afraid of “germs”, even if you do get sick, you are teaching your immune system how to be stronger in the future.
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