Slightly disappointed by Cecil’s coverage of this one. While I’ll admit that the literature on parasite infection vs. allergies is pretty sparse, there are two important facts I felt should have been in there:
Most allergies (it’s jolly dangerous to say “all”, so I shan’t) are caused by inappropriate immune responses (whatever the cause of that is, hygiene hypothesis if you like, it’s irrelevant).
Pretty much all parasitic helminths exhibit some kind of immune-evasion and a good number are responsible for some kind of immunomodulation.
What I’m saying is, stuff your hygiene hypothesis, there’s good support for saying the worm down-regulates your immune system which then ceases overreacting to all that nasty pollen.
Still, I’ll take hey-fever over worms any day, you never know what the little buggers are going to get up to in there.
Sorry I don’t have any references offhand, I did a dissertation on immune-evasion in parasitic helminths but it’s hardly a coffee-table read, I keep it somewhere dark, I think.
Question: do the worms actually lower your immune system’s functionality in general somehow (which would seem scary – you still want genuine pathogens and precancerous cells and the like to be recognized and taken care of, after all), or just give your immune system something to focus on other than its own body and flower pollen and cat dander and the like, or down-regulate specific parts of the immune response, or what?
Will infecting your body with hookworms cure your allergies? No. No one is claiming that. It’s more of an ongoing therapy. If you’ll tolerate the use of the word.
Jasper Lawrence has been a mixed blessing when it comes to helminthic therapy. He keeps a high profile and has attracted a lot of attention to it. Unfortunately, the story of how he acquired hookworms makes him seem in most people’s eyes to be a bit of a wacko. It then becomes hard to separate the scientific evidence from the guy who promotes it. That being said, there are lots of people who are eternally grateful that he made hookworms available to them. Some of them see him as a hero.
About the anemia, it’s not as bad as this column suggests. Just as hookworms can cause you to develop anemia, acetaminophen (Tylenol) can cause your liver to stop working – permanently. It’s a matter of dose. Most of the people who deliberately infect themselves receive between 50-100 hookworms. Some eventually take as many as 200. There are estimates that each 100 hookworms (of the Necator americanus species) will decrease an otherwise healthy adult’s hemoglobin level by 0.2 g/dL (normal is around 13-17 g/dL). For those starting out in this range, no one but a top level endurance athlete is ever going to notice the difference.
There are several small studies performed by real doctors and scientists, and reviewed in mainstream peer-reviewed medical and scientific journals offering evidence that it just might work. There are dozens of anecdotal tales which you can find in the yahoo chat group on “helminthic therapy” that make this even more interesting. If you ask in that chat group if you should give hookworms a try, the regulars will invariably tell you to “do your homework.” No one there suggests that you should try this on a whim.
This is highly experimental therapy. There are lots of unknowns. Can you acquire disease from the person hosting the parents of the hookworms that you’re using to infect yourself? While allergies may be less common in impoverished tropical regions, there are lots of other maladies that are more common. Can infecting yourself with hookworms make you more susceptible to them? What about cancer, will it be more likely?
Despite this, I think that a reasonable person can still deliberately infect oneself. It’s a question of desperation. Maybe you’re in your 30s and already obese and osteoporotic from prednisone. Maybe you’re about to lose 2/3 of your intestines to Crohn’s disease or ulcerative colitis. Maybe you can’t afford to spend $30k per year on multiple sclerosis medications. Maybe you can’t go outside of your house due to multiple chemical sensitivities. In those cases and others, giving hookworms a try may not sound so absurd.
Thank you, Cecil, for your information.Our experience on the subject : My wife had been fighting severe allergies and food intolerances for many years. About 8 months ago she inoculated herself with hookworms and now she is in clear remission.My advice to other people suffering from immune dissorders like Crohn, asthma, IBS, UC,chemical sensitivity and so many more would be : go to a yahoo group called helminthictherapy and start reading about the experiences of others with the same type of problems than you and what this therapy can do for them. Good luck.
Alberto
I remember as a medical student hearing a presentation of a case of T-cell chronic lymphocytic leukemia (much more rare than B-cell CLL). I asked one of the physicians in attendance why, if the prognosis was so grim and therapeutic options so limited, why didn’t we infect the patient with HIV? It is a T-cell killing virus, and HIV/AIDS takes years to develop. Given that the patient was elderly, it seemed that the risk/benefit was surely on the side of taking the risk.
The look I got in response to my innocent query was enough to make me forget about it. It is strangely reassuring to learn that “therapeutic infection” is not so crazy - in fact, it even won someone a Nobel Prize! That doesn’t make my particular suggestion right, but at least it’s not as irrational as the look I got from a faculty member for suggesting it.
Hookworms cannot reproduce inside you. Hookworm eggs take 1 to 2 days to hatch, and aren’t infectious until they go through 2 molts, which is complete after about 5 days. You don’t swallow them, as the article suggests, but they enter your skin as microscopic 3rd stage larvae. In nature, this typically happens when a person steps with a bare foot on some soil where someone defecated a while ago. When you are deliberately dosing someone you count out the worm larvae with a microscope, so you roughly know the number they will end up with.
Adult worms aren’t night-crawlers, but more like small hairs in your intestines. If you hadn’t been deliberately inoculated, generally you wouldn’t know you had them. After the initial period of adjustment they very rarely cause any side effects. The only exceptions to this seem to be in people whose immune systems are already in a very pathological state.
Each hookworm drinks 0.01ml-0.05ml of blood a day. (0.01ml is the far more frequently quoted figure.) At maximum, a colony of 100 hookworms might result in about twice the loss of iron per month a woman could experience through very heavy menstruation. Your body can up-regulate the iron it absorbs from your diet, so, unless you have a very iron poor diet, anemia shouldn’t be a problem.
The article compares hookworms to malaria, but this isn’t a reasonable analogy. Hookworms co-evolved with humans for millions of years, were ubiquitous, and were probably approaching a symbiotic relationship. In short, for many people they were (and are) supposed to be there, just like the kilogram of bacteria in their intestines is supposed to be there. The worm’s job is to serve as part of the control system for people’s immune systems, for without them it can become overactive and cause autoimmune diseases (not just asthma) or severe allergies.
Those few studies that have been conducted frequently don’t go on long enough, since hookworms can take up to a year to work. They also almost always use very light doses, and therefore don’t give the organisms a fair chance. Studies with other helminth species have similar problems.
It is extremely unlikely these organisms could serve as a vector for some disease. There is no general epidemiological evidence that N. americanus has ever served as a vector for any pathological agent, nor has there ever been any individual cases of this reported. These organisms have been studied for more than a century, and scientists have never identified them as carriers of any disease, despite the vast number of people in the developing world infected with them, where helminths, and many other diseases, are endemic. Let’s assume that about 500 million people in the world are currently infected with hookworms. (If we were to go back 50 years this number would have been far greater.) Let’s say that 1 in 100,000 of them both carries some disease that can be transmitted via hookworms, and someone catches hookworms from them. This would result in 5,000 transmitted cases of this disease. It seems inevitable that, for anything but the very rarest of diseases, this sort of connection would have been discovered by now. This line of reasoning also raises the question that, “If some such very rare disease were transmissible in this way, then why is it still so rare?” Given the widespread nature of this organism’s presence in human populations, both now and in the past, any disease that could be transmitted by them should be similarly widespread. The epidemiology of such a helminthic-disease connection would be quite apparent.
On a personal note, I’ve been hosting about 100 hookworms for about 3 &1/2 years. I got them from Jasper because I had a severe autoimmune disorder. They gave me my life back, and likely saved it, by putting me in essentially complete remission. If this is the placebo effect then it’s the most incredible placebo effect anyone has ever had. Hundreds of other people who have also been inoculated with hookworms would tell you a similar story.
Very interesting, James Lockwood. I read Jasper’s (well, the guy I presume is him) description on kuro5hin.org of how he re-infects himself, but I didn’t realize you guys actually count the worm larvae under a microscope before re-infection.
BTW, if you don’t mind me asking, what was your disorder, and how long did it take for you to get to the point where you felt essentially all better?
I had a number of conditions that stemmed from the same source, an immune system that was very overactive. Some of the minor ones were weeping eczema, skin papules, severe dandruff, and migraines. The big problem was unrelenting horrific anxiety. My immune system went insane, attacked my brain, and I went into a paranoid mania. I ended up in the mental hospital. (FWIW, this was the one and only time I have had any such difficulties.) After I got out, for the first 5 months (the worst of it) I slept 2 hours out of every 24. I would lie in bed saying to myself, “All I have to do is live for the next minute… and the next minute would come, and I would then repeat…” The only reason I’m still alive is that I was too savagely paranoid to kill myself. (It was a rather unpleasant catch-22.) I most certainly couldn’t work, and if I hadn’t had some resources I would have ended up on the street.
People will typically go through two bouts of cramping and diarrhea at about 20 and 24 weeks. After the second bout, for many people, your body has now fully adapted to the worms. (However, for some people full therapeutic effects can take up to a year.) The severity of these symptoms varies greatly and cannot be predicted. Mine were very mild. At 23 weeks and 5 days, right at the time when I had been having some loose stools, I remember standing in my room and realizing that for the first time in 18 months I felt normal. As I previously noted, it was a pretty big coincidence if just at the time the worms were supposed to fully kick in my symptoms just happened to disappear.
The people Jasper deals with are almost always extremely ill, they have a wide range of immune related disorders, and yet he is getting about an 80% remission rate. That is, 80% either go largely into remission, or into complete remission.
It depends on the species in question, each is different, but in general the former. Parasites are foreign organisms and pretty big ones too, in order to avoid getting killed and expelled they need to either hide from the immune system or combat it. Basically they take steps to weaken the immune system. I shan’t go into the incredibly dull details of the mammalian immune system here, but put simply, there are several different types of antibody and partly due to relative size the main target for a parasite like hookworm are the same ones that are responsible for allergies
It is not my intention to dispute anyone’s claim of a genuine therapeutic effect in anecdotal cases, and in general there is some interesting information in here, but I do have to raise this:
I can understand where you’re coming from and everything else you say there is interesting, but this bit just isn’t so. The only major flaw in Cecil’s comparison is the differing mortality rates between malaria and hookworm. Both are parasites, by nature they contribute nothing to the host but can cause harm. The fact that they can be potentially used for benefit is coincidence. Both co-evolved with humans, as all parasites have to by nature, it does not mean that they are meant to be there and there’s no evidence that I’ve ever heard of that they were even close to ubiquitous, even if they were, it would simply make them a pandemic.
I’m open to the idea of therapeutic use but let’s not dress the worms up as something they’re not. They’re a parasite which can potentially be leveraged for the benefit of a minority of the population, not a normal part of the wider species’ immune system.
Each region of Thailand has a specific main health issue, such as iodine deficiency in the North and liver fluke in the Northeast. For the South, hookworm infestation is No. 1. I don’t think anyone over here is very open to the notion of hookworms being beneficial.
The human body is a very complex system, and complex systems are designed to work in very particular ways. This is why when a random element is inserted, for example a mutation, it almost always is harmful. Even when people are carefully trying to chemically match this system for a specific application, for example, when they create a new molecule in the lab designed as a medicine to help people; almost inevitably it has side effects. From this reasoning, although it could be possible, it seems unlikely that the benefits from helminths are simply a matter of coincidence. Bolstering this idea is the fact that veterinarians report that horses, and other animals, will often have greater problems with allergies after they have been wormed, so it appears that helminths’ benefits also extend to other mammalian species. Does it seem likely that such a coincidence would extend across multiple species? Scientists are taking this idea seriously, for example:
As far as the idea of their being ubiquitous in human history is concerned, this is something which is commonly accepted in the community of autoimmune and allergy suffers who follow this therapy. Of course, people don’t literally mean that every human being, all the time, was always infected with helminths. What people mean is closer to the idea that helminths were very common, in the vast majority of human populations, throughout almost all of human history. They were therefore part of the expected environment in which humans evolved, and so the human genome evolved in accordance with their presence. Here is a quick quote I pulled from the web:
“Hookworms have been common in human civilizations, particularly around the Mediterranean, Africa and Asia, since the dawn of recorded human history. Usually the most susceptible communities are those with poor sanitation and/or a society without adequate foot protection. Shoes, sandals and boots prevent the hookworm from latching onto the skin, thus preventing infection. For example, in the early 20th century, the Rockefeller Sanitary Commission found a link between hookworm infestation and lack of shoe wearing in children and adults in America’s Southeastern states.” http://www.dailypuppy.com/articles/history-of-the-hookworm/603faab3-5d8b-f532-4034-a7fe548f80db
As a result of my first post there was some discussion on the helminthic discussion boards, and I need to make a few corrections:
A moderate number of hookworms do not present any real risk of anemia to a reasonably healthy person with a normal diet. The safety factor might be as high as around 50. However, if someone has a condition where their body can’t absorb iron properly, for example, if someone has a dysfunction of the small intestine, then there can be a risk of anemia developing.
You can’t really know the number of hookworms you carry, only the number you dosed with. Your body will often determine the number by responding to their presence and expelling additional worms beyond a given number. Sometimes this isn’t the case, but, unless you have had something like an endoscope, you don’t really know what’s going on in there. In any case, if you dose with reasonable number it is quite unlikely you will get yourself into any trouble.
I encourage anyone who is interested to find out more about this topic by looking at the links I provided in an earlier post. Autoimmune Therapies provides an extensive list of scientific papers on their site.
But, from what you’ve said about how they reproduce, you won’t end up with more hookworms than you dosed with, right? They can’t reproduce inside you, right? So the maximum you could have is the number you dosed with, but probably less because some of them probably didn’t make it … is that correct?
Just to be clear here, this means the safety factor is around 50 times the number of hookworms you would typically be using. So you might need to have around 5,000 worms before you would typically be in danger of developing anemia. (I’m definitely not saying that this number would be in any way advisable.)
Hi James : concerning the difficulty of measuring the actual HW population and the guess of a 50% rate of atrition , I would like to ask a question : are you familiar or you know of anybody using kinesiology on this context ?.Thanks. Alberto
Sorry Alberto, I’m afraid I’ve never heard anything about using kinesiology in this context. You might post this question on the helminthic therapy board, since someone else might have run across this idea.
Hi Occam1 : I would like to support your idea that to inoculate oneself with hookworms is a question of desperation and,as well , to speculate about the reasons for said desperation.
It seems that 2 of the common denominators of the diseases produced by the immune system imbalances that the HW try to correct ( MS, asthma, IBD, IBS, UC, Chron, coeliac, diabetes,etc, ) are : 1. they are chronic and 2. they usually produce inflamation.
Concerning the first, the reason is clear : modern medicine can not cure them because it does not yet know how the immune system really works. Instead ,it offers drugs to treat the symptoms and surgery as a final solution if necessary.
Unfortunately many of theese drugs produce dangerous side effects ( like NSAIDS blocking the CoQ10 pathways and so leading to Alzheimer ).
And that could explain the desperation ; when having to choose between long term inflamation, leading to cancer, or NSAIDS leading to Alzheimer ( or surgery which is a finite solution ) no wonder some people decide in favour of the worms.
Just in case it is not yet totally clear, please note that I am no biochemist but just another desperate punter looking for permanent solutions. In any case, any correction or feedback about this subject or my opinions will be apreciated as I am here to learn from others. Thank you. Alberto
It varies though…I know of another person who tried, and it didn’t help. I have Ulcerative colitis, first tried this about five years ago, via a German company called Ovamed that provides sterilized whipworms. It didn’t cure me, but I stabilized where it’s more manageable (I was really really sick before, where I was wasting and unable to digest anything, now I’m fairly stable if I stick to a very limited diet).
The process takes a few months; every two weeks I took a vial of worm eggs, for like three months. And yes, it was thousands of dollars, but to me it was worth it.
It also seemed to cure food allergies/sensitivities I had, to red wine and eggs.
At this point, they just don’t have enough data to judge effectiveness.