Human helminth care manual

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    PLEASE READ THIS FIRST

    This manual is only concerned with the two human helminths:

    • Human hookworm - Necator americanus (NA) [1]
    • Human whipworm - Trichuris trichiura (TT) and its ova (TTO) [2]

    For the care of the non-human helminths, TSO and HDC, see the Helminth care page.

    Key

    The following classification codes are intended as a general guide only, because the effects of a substance can vary considerably depending on factors such as quantity, concentration, and, in the case of herbal extracts, the part of the plant used. Even the method of extraction can make a difference, and, in the case of foods, perhaps the method, temperature and duration of any cooking, [3] so it's important to read the details for each item.

    ❌ Will or may kill, or cause the loss of, human helminths.
    ⚡ May cause harm to human helminths in some people.
    ➿ May cause a temporary reduction in benefits from human helminths.
    ❓Insufficient evidence exists to support a judgement on possible effects.
    ✅ Safe, or likely to be safe, for human helminths.

    Note that where an entire section is marked with a ✅, this indicates that all the substances listed within that section are safe unless marked otherwise.

    Using this manual

    * Bookmark this page to facilitate rapid access whenever it is needed.

    * To find information about a specific substance, don't scan the page visually. Instead, use the search function on your device:

    • PC - Control+F
    • Mac - Command+F
    • Mobile - "Find in page" in the drop-down menu from the three dots icon

    * If no search results are found (and your spelling is correct) the substance is far more likely to be safe than unsafe for therapeutic human helminths.

    General advice

    NA and TT are relatively robust organisms, and most foods, drugs and other substances are safe for use while hosting them, including normal dietary amounts of most unprocessed foods, spices and herbs. However there are some foods and other substances that may harm a colony, either temporarily stunning them or even killing them.

    Things that will or may kill, or cause the loss of, human helminths include:

    Some foods can cause harm to NA and TT in some people but not others, and coconut products are a good example of this. While many hosts of human helminths are able to eat normal dietary amounts of coconut products without affecting their worms, others find that some forms of this food will affect their worms sufficiently to impair their beneficial effects.

    The most common food items that may affect helminths in some people but not others are:

    If hosting NA, it is best to avoid the food substances listed above until the therapy is delivering benefits, at which point their effect on one’s colony can be tested, initially in small, and then in gradually increasing, quantities to assess the level of risk they are likely to present, and how much of each substance might safely be consumed before the worms are affected.

    See the rest of this page for other items marked with a ⚡ or ❌.

    Medicinal quantities of concentrates, extracts or tinctures, especially of certain herbs, are more likely to have an adverse effect on NA and TT than the plants from which they are derived. For example, eating normal dietary amounts of ginger is usually fine, as is occasionally taking a ginger supplement (e.g., to treat a migraine), but taking ginger regularly as a supplement or drinking ginger beer every day may adversely affect NA.

    Anther example of how the concentrated form of a substance can be harmful to helminths while foods containing the same substances are not are the phytochemical compounds, isomyristicin and bergaptenix. While the concentrated forms of isomyristicin and bergaptenix have shown significant anthelmintic activity against two helminth species, the parent chemicals from which they are derived (myristicin and bergapten) are both found in several of the fruits, herbs and vegetables consumed by humans on a daily basis, e.g., parsley, celery, lemons, figs, carrots, grape juice, nutmeg and dill, and the risk of an anthelmintic effect from this very limited dietary intake is negligible. [4]

    People who have a robust immune response to helminths are likely to notice a greater effect on their worms than others. These individuals are the ones who need to top up their human helminth colonies more frequently in order to maintain remission from their disease. Typically, they have Crohn's, or one of the other intestinal diseases, but a few in this group have other conditions, such as allergies. [5]

    It is thought to be less likely that anything will harm NA before it attaches to the gut mucosa towards the end of the third week post inoculation, although, once NA enters the bloodstream, it does begin to feed on proteins in the blood. [6] [7]. After it arrives in the small intestine and begins feeding from the gut wall from day 21, NA will always be vulnerable to anything harmful that has entered its host's blood.

    Substances that are applied to the skin topically in small quantities are unlikely to cause harm to human helminths, even if they are known to be a risk when ingested.

    Due to the way that TT feeds and attaches to the colonic mucosa, it is not as vulnerable as NA, as is illustrated by the fact that three times more of the anthelmintic drug, mebendazole, may be required to kill TT than to kill NA.

    Substances listed on the internet as being "antiparasitic" may have no effect whatsoever on NA and TT. Helminths are only one of many different types of parasite. Among the other types, there is a wide range of responses to substances claiming to be antiparasitic, and what kills one type of parasite may not even harm another. Even substances that have shown an anthelmintic effect in test tube studies do not necessarily have an adverse affect on worms being hosted by humans. [8]

    The effects that foods and other substances have on helminth egg production may not be the same as the effects they have on the prophylactic or therapeutic benefits of adult helminths. Consequently, the details on this page may not be relevant to the practice of helminth incubation. A tentative examination of the effect of substances on the production of hookworm eggs and larvae can be found in the page section, Promotion of egg viability by dietary manipulation.

    The posts in this support group sub-thread contain good general advice on how to manage exposure to substances that can harm human helminths.

    Worm harm denial

    A few people have difficulty accepting that any of the substances mentioned on this page might harm helminths, with the exception of anthelmintic drugs. They believe that the adverse effects on human helminths that have been reported by self-treaters have alternative explanations, including delusion on the part of the reporting individual. They argue that, were the claims true, there would no longer be large areas of the planet where these worms remain endemic, and that the substances/foods/spices identified by self-treaters as potentially harmful to human helminths would have become folk remedies for helminth infections. However, this position ignores the science (e.g., Herbal anthelmintic agents: a narrative review) and the fact that the effect of consuming a food or product with anthelmintic effects will be much less of an issue, if it is even noticed at all, in populations that are continually exposed to helminths and therefore constantly being reinfected.

    In the words of one experienced NA self-treater:

    Quotein.gif
    Respect the foods and other items in the care manual that are likely, or potentially, unsafe for helminths. I’ve learned the hard way that coconut oil/milk/flour, raw ginger, curry, etc. are no beuno for my friends on board, and as much as I enjoy those things, they are not worth knocking out my NA for a week or multiple weeks. Everybody’s different here and it’s worth testing in very small amounts. [9]

    Updates & disclaimer

    This manual is updated regularly. See the page history (via the "View history" link at the top of the page) for a list of amendments.

    Although the most harmful substances have been identified, this manual continues to be a work in progress so should not be viewed as definitive. Also see the General disclaimer.

    Details in this manual are based on first hand reports posted in the Helminthic therapy support groups. Additional reports and comments on this topic are welcomed, and should be posted to the Helminthic Therapy Support group on Facebook.

    Pharmaceuticals

    Anaesthetics (anesthetics), General [10]

    ✅Nitrous oxide (N2O) (E942) [11]

    Nitrous oxide (aka laughing gas or sweet air) was, at one time, mistakenly thought to kill hookworms. However, when this gas was used by people who wanted to terminate their hookworm colonies, their attempts met with failure. One subject reported inhaling almost a full can of whipped cream at 3 weeks post inoculation in an attempt to resolve severe side effects, but with no obvious effect on his hookworms. In another case, a balloon full of nitrous oxide failed to have any effect on a hookworm colony, which was later confirmed to be viable by a stool test. [12] Then, in 2017, the notion that nitrous oxide harms NA was finally laid to rest by someone who inhaled a large quantity of the gas over the course of an hour. This individual reported that, although he did get a headache and giggled a lot, his worms were not harmed.

    ✅ The following forms of nitrogen are also unlikely to be a problem for hookworms.

    • Nitric oxide (NO) [13]
    • Nitrogen dioxide (NO2) [14]
    • Nitrate (NO3) [15]
    • Pure nitrogen (N) [16]
    • Liquid nitrogen (LN2) [17]

    Other general anaesthetics

    It has been suggested that the volatile organic compounds (VOCs) that were used in the early days of anaesthesia might be a risk to hookworms, especially if inhaled in excessive quantity, due to the possibility that they might stun them and cause them to be expelled from the gut before waking up. For example:

    However, a clinical scientist has reported that, while hosting both NA and TT, he worked around more organic solvents, including dichloromethane (CH2Cl2) and chloroform (CHCl3), than most people are exposed to in a lifetime, and that his hookworms and whipworms continued egg production uninterrupted.

    ✅ Propofol While propofol has been shown to adversely affect the mitochondria of roundworms in laboratory conditions, it is clear from the experience of hosts of both hookworms and whipworms that propofol does not harm human helminths in the concentrations used during surgery.

    ✅ Regional nerve blocks are worm-safe.

    Anaesthetics (anesthetics), local [18]

    ➿ Local anaesthetics

    Local anaesthetics interfere with the production of white blood cells as well as the functioning of the cells in circulation, but they appear not to affect ova production by helminths and they certainly don't kill them. While local anaesthetics can cause a temporary return of disease symptoms for up to 8 weeks, helminths generally recover after only a few days, although this varies by person, drug and dosage, making it difficult to predict exactly what will happen in any particular situation.

    For dental procedures requiring a local anaesthetic, short-acting drugs are less likely to affect helminths, e.g.

    • Articaine (articadent, astracaine forte, septanest, septocaine, ubistesin forte, ubistesin, ultracaine, zorcaine)
    • Lidocaine (xylocaine, lignocaine)

    These are a better choice than a longer-acting drug, such as

    and one helminth host has reported that the short-acting articaine had no adverse effect on his hookworms.

    If a patient explains that they don't want to be numb for several hours, the dentist will usually use one of the short-acting drugs, or one combined with a vasoconstrictor such as epinephrine, which helps to reduce the amount of the drug that reaches the systemic circulation.

    If local anaesthetics are used, it can be a good idea to arrange for a small supplementary dose of worms (e.g., 3 or 5 hookworm larvae) to be available for administration the day after exposure to the drug. This small additional inoculation usually helps to reduce the time that established helminths are out of action.

    ✅ Alternatives to local anaesthetics

    These drugs all appear to be harmless to helminths, so, taken orally at high strength, these may be a suitable substitute for local anaesthetics in many situations. For example, one helminth host has found that 30 mg dihydrocodeine, taken along with 1,000 mg of paracetamol (acetaminophen) an hour or two before a dental appointment can be effective in avoiding all but a few brief moments of mild, dull pain, which he found to be quite manageable. This subject even found that the combination of dihydrocodeine and paracetamol (acetaminophen) provided adequate pain relief when having a tooth sculpted to take a crown. Aspirin and ibuprofen are also harmless to helminths, so, if preferred, these might provide a suitable alternative to paracetamol (acetaminophen).

    Another option for completely avoiding any risk to helminths from local anaesthetics was the GumEase cryoallergenic mouthpiece. This device, which is apparently no longer available to purchase, provided pain relief for up to 20 minutes, and was appropriate for most procedures, including fillings, crowns, extractions and root canals. Previously available from two sources [19], [20] this device unfortunately never caught on with dentists who are firmly wedded to the use of injectable drugs.

    Another pain-free alternative is laser dental surgery, which is likely to become increasingly available in the future. If more invasive dental surgery is required - where bone needs to be removed, for example - it may be best to request conscious sedation. This renders the patient unaware of what is taking place, but is not the same as a general anaesthetic. Conscious sedation might involve a combination of versed (a short acting IV benzodiazepine) and fentanyl (a short acting IV opiate), both of which are perfectly safe for worms.

    Anaesthetics (anesthetics), topical [21]

    ✅ Topical anaesthetics (e.g., lidocaine / lignocaine) that are applied to the skin are unlikely to affect helminths within the digestive tract because not enough of the drug will get into the blood stream to affect the worms. Topical lidocaine used before blood draws, punch biopsies and the fitting of a catheter, or applied to the mucous membranes in the mouth or nose, are therefore worm-safe. However, there is a small possibility that fresh L3 NA larvae, which remain within the skin at the inoculation site for the first 40 hours, may be adversely affected by the use of a topical anaesthetic applied directly to this area following inoculation. [22] Further feedback is needed to confirm or dispel this possibility.

    Anthelmintics [23]

    ❌ Anthelmintic drugs

    A number of drugs are used to terminate helminth infections, but the effectiveness of different anthelmintics against a single species varies greatly. In one study, a triple dose of albendazole (3×400 mg over 3 consecutive days) showed a cure rate against hookworms of 92%, whereas a triple dose of mebendazole (3×500 mg over 3 consecutive days) only achieved a cure rate of 58%.

    Each anthelmintic drug has varying degrees of effectiveness against different helminths. For example, while a triple dose of albendazole (3×400 mg over 3 consecutive days) showed a cure rate against hookworms of 92%, the same regimen only achieved a 56% cure rate against whipworms [24] and, in patients with an excessive whipworm infection, albendazole may need to be taken for 5–7 days. [25]

    If it becomes necessary to terminate a colony of helminths, a medical doctor should be consulted, and their directions followed. However, under no circumstances should mebendazole ever be combined with metronidazole (Flagyl), and this is something about which many doctors and pharmacists may be unaware. There is a risk that this combination may cause Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.

    List of anthelmintics

    • Arecoline (Arecaline, Arecholine, Arecolin, Arecoline base, Arekolin, Methylarecaidin.)
    • Bephenium hydroxynaphthoate (Alcopar, Alcopara, Befenium, Debefenium, Francin, Nemex). This is an anthelmintic agent once used to treat hookworm and roundworm infections.
    • Diethylcarbamazine (DEC, Hetrazan, Carbilazine, Caricide, Cypip, Ethodryl, Notézine, Spatonin, Filaribits, Banocide Forte and Eofil)
    • Isomyristicin and bergaptenix are two phytochemical compounds isolated from the Bhutanese medicinal plants, Corydalis crispa and Pleurospermum amabile, which have shown significant anthelmintic activity against the helminths, Schistosoma mansoni and Trichuris muris. In concentrated form, they may therefore be harmful to other whipworms and possibly also hookworms. [26] However, it should be noted that myristicin (the parent chemical from which isomyristicin is derived) and bergapten are both found in very small quantities in the vegetables, herbs and fruits consumed by humans on a daily basis, e.g., parsley, celery, lemons, figs, carrots, grape juice, nutmeg and dill, but the risk of an anthelmintic effect from this very limited dietary intake is negligible. [27] These chemicals are also found in ⚡ Earl Grey tea, which is flavoured with bergamot oil, and one hookworm host has reported that she experienced a return of symptoms of her disease (POTS) after drinking this brew. However, there are many other NA hosts who drink this tea without any problem, including someone who drinks multiple cups each day of weak Lady Grey tea (citrus bergamot flavour) and has reported still being able to successfully incubate from her small NA colony. [28]
    • Levamisole (Decaris, Ergamisol) is an antihelmintic drug approved for use in veterinary medicine in the United States. It was once used in the treatment of rheumatoid arthritis but proved too dangerous.
    • Nitazoxanide (Alinia, Nitaxide) is a broad-spectrum antiparasitic and broad-spectrum antiviral drug used to treat various helminthic, protozoal and viral infections. It has demonstrated activity against tapeworms, [29] so may also have an adverse effect on hookworms and whipworms.
    • Odanacatib (codenamed MK-0822) is an investigational treatment for osteoporosis and bone metastasis developed by Merck & Co., and possibly available for clinical use from 2016. Unfortunately, this drug has been shown to kill the hookworm, Ancylostoma ceylanicum, in hamsters, decreasing worm burdens by 73%. [30] Consequently, it is likely to be trialled as a potential alternative to albendazole and may have an adverse effect on the human hookworm as well as other helminths, so should be avoided by helminth self-treaters.
    • Penicillium cluniae (a fungus species of the genus of Penicillium which produces the antinematodal and antiparasitic agents paraherquamide B, paraherquamide C, paraherquamide D, paraherquamide E, paraherquamide F, paraherquamide G, paraherquamide H.)
    • Phenothiazine (PTZ) This is considered to be the first modern anthelmintic, introduced for this purpose in 1940.

    • Piperazine (piperazine hydrate and piperazine citrate are anthelmintic drugs that kill 60-70% of adult roundworms) and piperazine's many derivatives.
    • Pyrvinium (Vanquin, viprynium). This anthelmintic was previously used to treat pinworm (Enterobius vermicularis) infections, but has been largely replaced by other anthelmintics, e.g., mebendazole or pyrantel pamoate.
    • Tiabendazole (thiabendazole, TBZ, Mintezol, Tresaderm, Arbotect, etc.)

    ❓ Piperazine-derived compounds

    There is a whole raft of piperazine-derived compounds some of which may potentially have anthelmintic effects. However, this does not mean that all piperazine derivatives will kill, or even harm, helminths. For example, ✅ Viagra is a piperazine derivative, but does not kill hookworms.

    • These include many antidepressants including
      • trazodone (Depyrel, Desyrel, Molipaxin, Oleptro, Trazodil, Trazorel, Trialodine, Trittico). One self-treater has been reported to take trazodone almost every night, but continues to get "great results" from her NA. [31]
    • antipsychotics such as
    • the migraine treatment
    • and antihistamines including
      • buclizine,
      • ⚡ cetirizine (Zyrtec, Reactine),
      • chlorcyclizine (Di-paralene, Mantadil, Pruresidine, Trihistan),
      • cinnarizine (Stugeron, Stunarone, R5),
      • cyclizine,
      • ⚡ levocetirizine (Xyzal) (one NA host has reported having no problems with her worms when taking this [32]),
      • meclizine (Bonine, Bonamine, Antivert, Postafen, Sea Legs,
      • ⚡ dimenhydrinate (Dramamine, Draminate, Gravol, etc.) While one NA host has reported that taking this drug had no observable effect on her worms, [33] someone with colitis believes that it killed at least some of her NA colony.
      • niaprazine
      • ebastine (Evastin, Kestine, Ebastel, Aleva and Ebatrol) Listed as a piperidine.
    • as well as antianginals, anxiolytics such as
      • ⚡ buspirone (Buspar), (one self-treater found that the positive effects of NA were lessened in the days following a single dose of buspirone [34])
    • urologicals, e.g.

    Anthelmintic residues may be encountered in farmed meats, especially the livers of cattle and fowl, but it is not known whether, or to what extent, these might affect therapeutic helminths in hosts who eat this meat.

    Canine anthelmintics that have been applied to a dog’s skin should not be a problem for anyone who pets a treated animal so long as they wash their hands immediately after the contact. [35]

    Antibiotics [36]

    (Also see Natural antibiotics.)

    ❌ Antibiotics that may significantly reduce hookworm benefits

    • Cefazolin (Also known as cefazoline and cephazolin.) Someone who was given a 1 gram shot of cefazolin post-operatively estimates that she suffered a 60% loss of effect from her hookworms for several weeks. She began to feel better after a 3-day course of prednisone taken one month after the cefazolin exposure, and was mostly back to normal at 6 weeks.
    • Levofloxacin has been reported by one NA host as having "completely devastated" her colony. An egg count revealed only 14 ova, and she went from near total remission to a severe flare. "Back to ground zero." [37]

    ⚡ Antibiotics that may reduce hookworm benefits in some people

    • Amoxicillin While two hookworm hosts have said that they did not lose their worms following treatment with amoxicillin, two others have reported losing their colonies after taking this drug. Combination drugs that contain amoxicillin e.g., amoxicillin/clavulanic acid (co-amoxiclav, Augmentin) can also be a threat to human helminths, as was found by a hookworm host whose colony was temporarily "knocked out" after taking amoxicillin and clindamycin together. [38]
    • Azithromycin (brand names include: AZIF-500, Azithral, Azithrocin, Azyth, Azin, Z pack, Zeto and Zithromax) Someone has reported losing her hookworms to a combination of azithromycin (an azalide, a type of macrolide antibiotic) and doxycycline (see below) (a broad spectrum antibiotic of the tetracycline class), whereas a whipworm host did not lose her colony from taking this same combination of drugs. Azithromycin has been used on its own to treat a child with PANDAS and a female adult with an ear infection [39] without any worm loss, although its use did result in a temporary suspension of benefits in both cases.
    • Clindamycin has been suspected of possibly harming hookworms when taken in combination with amoxicillin or metronidazole, but two NA hosts who took this drug on its own have reported that it had no adverse effect on their colonies. The first took clindamycin for 10 days (starting in the first week of hosting), [40] and the second took a 7 day course (300mg taken 4 times per day) after which a float test revealed plenty of hookworm eggs. [41]
    • Doxycycline (Vibramycin, Monodox, Microdox, Periostat, Vibra-Tabs, Oracea, Doryx, Vibrox, Adoxa, Doxyhexal, Doxylin, Doxoral, Doxy-1 and Atridox, etc.) is a tetracycline antibiotic that also has antiprotozoal, antibacterial and some anthelmintic effects, although the latter have been claimed to only affect filarial nematodes. In this case, the drug kills a symbiotic bacterium in the worm’s reproductive tract, thus rendering it sterile. Moreover, an eight-week course of doxycycline may be necessary to achieve this effect. One hookworm host has reported that he took doxycycline for a total of 5 weeks without noticeable effect on his worms, but another has said that her hookworms “completely stopped working” after taking doxycycline for only three days. She said that this happened “pretty much overnight”, and that, in spite of getting a supplementary dose of worms a month or so after taking the antibiotic, [42] she didn’t feel right again for the following 6 months. [43] (NB: doxycycline has also been found to have unexpected effects on mitochondria.)
    • Flucloxacilin, also known as floxacillin. When one hookworm host took this drug with probenecid (which is sometimes used to increase the concentration of some antibiotics), she experienced a return of her disease symptoms, although these were not as severe as they had been before she began hosting NA. An incubation yielded only half the usual number of larvae, but, after taking a wake up dose of 12 NA, she was feeling much improved 3 weeks later. [44] Someone else who had a 10 day course of Flucloxacilin, firstly intravenously, and then orally, found that she lost benefits from her NA for 4-6 weeks. She knew the worms were not dead because she was able to incubate fresh larvae from her colony. On a different occasion, a shorter course of 5 days IV, then oral Flucloxacilin, had minimal impact. [45]
    • ❓ Fosfomycin (also known as phosphomycin, phosphonomycin, Monurol and Monuril) A single, one-off, 3g dose if this broad-spectrum antibiotic that was taken by a hookworm host to treat a urinary tract infection had no obvious effect on her worms. [46] However, larger doses or a longer treatment period may produce a different result.
    • Metronidazole (Flagyl). Two hookworm hosts have reported losing their colonies to metronidazole (Flagyl), [47] [48] which may be particularly harmful to hookworms if taken in combination with clindamycin (Dalacin, Lincocin, Daclin). Metronidazole and clindamycin are favoured by some dentists due to their proven efficacy against anaerobic bacteria. However, when take on its own, metronidazole does not always kill hookworms, as one host found when she had to take this drug along with amoxicillin for several weeks to treat septic gangrenous appendicitis, [49] and another found when he needed to take 750mg daily for 7 days to treat SIBO. [50] A third NA host was still able to successfully incubate more larvae after taking five doses of 400mg metronidazole daily for three days. [51]
    • Quinolones. Drugs in the quinolone family have been shown to block a detoxification pathway required by helminths for blood feeding, resulting in arrested development of L3 larvae and adversely affecting the reproductive capacity of adult worms both in vitro and in vivo. [52] (NB. In 2018, the European Medicines Agency began to recommend restrictions on the use of fluoroquinolone and quinolone antibiotics on safety grounds, [53] and, in 2019, fluoroquinolones were linked with heart problems. [54])

    ✅ Antibiotics that appear not to affect hookworm benefits

    • Mycophenolic acid Also called mycophenolate mofetil (MMF, trade name CellCept) and mycophenolate sodium (trade name Myfortic), this antibiotic/immunosuppressant drug has broad-spectrum antiviral, antifungal and antibacterial properties, but has not been commercialised as an antibiotic due to its adverse effects. One hookworm host has taken CellCept (500mg x 3 per day), apparently without harming her colony. [55] [56]
    • Rifaximin (Xifaxan, Xifaxanta and Normix, etc.) This drug is poorly absorbed when taken by mouth and stays within the gastrointestinal tract, so is unlikely to affect NA, which feed directly on their host's blood, and will pass by TT while they are grazing on tissue secretions within the intestinal lining. The drug's lack of effect on NA was confirmed by one self-treater who took a 14 day course of the drug to treat SIBO and had no return of symptoms from his sinus condition, and only noticed a minimal effect on egg production by his worms. [57]
    • Trimethoprim (Alprim) One hookworm host has reported continuing to enjoy full benefits from her worms after taking seven 300 mg doses of this drug to treat a urinary tract infection. Another has reported that, when used to treat UTIs, Alprim not only did not affect her hookworm colony, but did not even arrest the production of ova by her worms. [58]
    • Topical antibiotics If applied to the skin, or used as eye drops, these are unlikely to affect helminths in most cases. Four drops of 0.3% Ciloxan (ciprofloxacin) applied to each eye 3 times each day for 2 weeks had no effect on the colonies of two hookworm hosts, [59] and tobramycin eye drops applied 3 times each day for 2 days, and twice each day for the following 3 days, had no obvious ill effect on another hookworm colony. [60]

    General discussion

    Short courses of most other antibiotics will typically only cause a temporary loss of benefit for between 2 and 8 weeks (e.g., ➿ erythromycin [61]), although it is possible for efficacy to be reduced for longer, e.g., 4 months, and even 6 months, and there is anecdotal evidence suggesting a correlation between the length of a course of antibiotics and the length of time that affected helminths are out of action. This might suggest that a single shot of antibiotic might have little or no effect on human helminths, as has been reported by one hookworm host, [62] but the type of antibiotic used may be critical in this case, and some antibiotic drugs might adversely affect a helminth colony even when only a single injection is administered. This happened when one hookworm host was given a single, 1 gram shot of cefazolin. See Cefazolin for details.

    It is possible that even a small dose of antibiotic could cause a return of symptoms in some people. For example, one hookworm host has reported experiencing a recurrence of significant disease symptoms after using 3 drops per day, for only 1½ days, of a solution containing tobramycin 3mg (0.3%).

    In cases of dental infection that would routinely be treated by a course of an oral antibiotic, it might be possible to avoid the use of a drug if the dentist is able to use localised ozone injections. [63] [64]

    When it is essential to take oral antibiotics, the duration of their negative effect on hookworms can be significantly reduced - perhaps to as little as 2 weeks - by taking a small top-up dose of no more than 5 larvae after finishing the course of drugs. In most cases, this inoculation can be carried out 48 hours after the last dose of the drug, but it's worth asking a pharmacist exactly how long the prescribed drug will take to clear completely from the body. Different antibiotics have different biological half-lives. For example, erythromycin's half-life is only a couple of hours, whereas penicillin's can be up to 56 hours.

    An alternative to taking a small top-up dose of NA would be to take 500 TSO. One NA host reports that, without a helminth top-up, it usually takes her 4-6 weeks to come right after an infection. But, if she takes 500 TSO after completing the antibiotics, she recovers within about 10 days. [65] If ordered at the same time as the antibiotics are started, TSO will arrive in time to be taken after the course of the drug is completed. And, since TSO remain viable for a couple of years in a fridge, a small supply of them can be kept to hand.

    It has been suggested that the reduction in the benefits derived from hosting human helminths that is seen after taking antibiotics might result, at least in part, from a loss from the gut microbiome of helpful bacterial species and the proliferation of less beneficial ones. This suggestion, and the fact that taking probiotics alongside antibiotics has been claimed to help offset the gastrointestinal symptoms typically associated with these drugs, has led to the suggestion that the use of high doses (perhaps 5 or 10 times the normal dose) of good quality probiotics might help to reduce the time that helminths are out of action after using these drugs, especially if the probiotics are taken at a different time of day from the drug. And this effect has been reported by one individual. [66] However, also see this article which looks at the evidence on the use of probiotics alongside antibiotics, which is not all positive. Additional help in protecting the microbiome might be gained by supplementing with either butyrate [67] or charcoal [68] alongside an antibiotic, and a fecal microbiota transplant (FMT) following treatment with an antibiotic might also help to restore worm benefits more quickly. [69]

    It is possible that the consumption of prebiotics such as galacto-oligosaccharides (GOS) may also help to restore the gut biome, since GOS has been shown to help support the recovery of beneficial bifidobacteria and increase the production of butyrate, after antibiotic treatment. GOS is available in the form of Bimuno Prebiotic Powder. Fructooligosaccharides (FOS) and xylooligosaccharides (XOS) may perform a similar function. [70] For more detail about the effects of a total loss of worms due to antibitoic use, and how to restore a colony, see Colony collapse.

    In the case of someone needing to take antibiotics regularly, or on a long-term basis, there would be little point in them using hookworms until completely off these drugs. Some worm benefits may be maintained in users of the human whipworm, so long as doses of this organism are being taken regularly, every few weeks. Another solution for those who need to take antibiotics frequently, or for prolonged periods, would be to switch to TSO as these are less likely to be adversely affected by antibiotics. While ciprofloxacin is capable of blocking the action of TSO, other antibiotics just slow them down. [71] HDC may also be less susceptible to antibiotics than human helminths, although two users of HDC have reported that the antibiotic, ⚡ Dapsone (diamino-diphenyl sulfone), causes a return of their disease symptoms.

    ➿ Antibiotics best avoided for other reasons

    Some antibiotics are best avoided for other reasons.

    • Clarithromycin (Biaxin, etc.) has been shown to increase the risk of a fatal heart attack compared with penicillin V, especially in older people with existing cardiac risk factors, although no increased risk was seen with roxithromycin [75]. Also see this later study.

    Anticoagulants [76]

    ✅ Safe anticoagulants unless otherwise marked

    Anticoagulant medicines and herbs (which reduce the clotting ability of blood) do not harm helminths, but may prolong bleeding from the tiny feeding sites of hookworms, which, themselves, secrete minute amounts of anticoagulants to help their digestive process. Anticoagulant drugs include:

    Other drugs that have an anticoagulant effect include

    Herbs with an anticoagulant effect include:

    All of these compounds may prolong bleeding at hookworm feeding sites to some extent, so may potentially contribute to anaemia (anemia) in susceptible individuals, especially if several of these drugs/supplements are taken at the same time.

    Antidepressants

    Some self-treaters use certain SSRIs alongside NA and TTO without any apparent problem, but, according to a 2018 Nature article, [77] some SSRIs (setraline, paroxetine, and chlorpromazine) have such a powerful anthelmintic effect that the authors suggested these drugs could be used clinically as dewormers.

    NB Anyone who wants to start helminthic therapy who is already taking one of the antidepressants that has a known anthelmintic effect should not stop taking the drug without first consulting their medical advisor. This is because, although helminths can eventually help in some cases of depression, the worms are unlikely to start to work immediately and may actually cause a brief initial worsening of this condition before beginning to provide relief. See Helminthic therapy and neuropsychiatric function: Depression.

    • ✅ Amitriptyline (Elavil, etc.) This tricyclic antidepressant has been taken by at least one hookworm host at 15 mg per day, without issue. [78]
    • ✅ Citalopram (Celexa, Cipramil and numerous other names.) This selective serotonin reuptake inhibitor (SSRI) has been used by at least one hookworm host with no ill effect on her colony. [79]
    • ✅ Doxepin This tricyclic antidepressant and potent antihistamine has been marketed under many names, including Quitaxon, Aponal and Sinequan. One individual has taken Doxepin daily for several years while hosting hookworms, without noticing any adverse effect on his colony. [80]
    • ✅ Duloxetine (Cymbalta, etc.) This Serotonin–norepinephrine reuptake inhibitor (SNRI) was taken by one NA host for several years to treat generalised anxiety without any obvious effect on her worms. [81]
    • ✅ Fluoxetine (Prozac, Sarafem, etc.) A study published in Nature reported that this selective serotonin reuptake inhibitor (SSRI) was harmful to the non-theraputic helminth species C. elegans, [82] but fluoxetine is being taken by at least two hookworm hosts without issue [83] [84].
    • ❓ Venlafaxine (Effexor, etc.) There have been no reports about this particular drug yet, but it is a serotonin-norepinephrine reuptake inhibitor (SNRI), and it is already known that duloxetine (Cymbalta, etc.), which is another SNRI, appears to be safe for use by hosts of human helminths.
    • ❌ Desvenlafaxine (Pristiq, Desfax, Ellefore, etc.) One hookworm host has reported that this drug wiped out his entire NA colony.
    • ⚡ Escitalopram (Cipralex and Lexapro.) After taking "the smallest possible dose" of this selective serotonin reuptake inhibitor (SSRI) in the form of Lexapro for 4 weeks, one user found that she lost all the benefits previously conferred by NA, and even HDC benefits were dampened. [85]. However, someone else who took Lexapro for the first 2.5 years that she hosted NA did not lose her colony as a result of this. She was already taking 30 mg per day when she first inoculated, and then lowered the dose to 20 mg 18 months later. This user does have to top up her colony with a dose of 10 NA every three months, but this level of attrition is not excessive and may not be due to the drug. [86] Others have reported taking Lexapro without any obvious adverse effect on their NA, e.g, this self-treater and someone else who had hosted NA for 7 years and been taking Lexapro during this entire time (10mg for 5 years, then 5mg for 2 years, and finally 2.5mg once a week for 3 years [87]) and was never aware of this having any adverse effect on his worms.
    • ❌ Paroxetine (Aropax, Brisdelle, Deroxat, Paxil, Pexeva, Paxtine, Paxetin, Paroxat, Paraxyl, Sereupin, and Seroxat.) This antidepressant of the selective serotonin reuptake inhibitor (SSRI) class, has shown anthelmintic effects against three widely divergent helminth species. It kills C. elegans at multiple life stages and acts rapidly to inhibit its feeding within minutes of exposure. It also decreases motility in the adult mouse whipworm, Trichuris muris, prevents hatching and development of the dog hookworm, Ancylostoma caninum, and kills the blood fluke flatworm, Schistosoma mansoni. [88]
    • ❓ Sertraline (Sold under a very large number of trade names, [89] including Zoloft.) This antidepressant of the selective serotonin reuptake inhibitor (SSRI) class has shown anthelmintic effects against three widely divergent helminth species. It kills C. elegans at multiple life stages and acts rapidly to inhibit its feeding within minutes of exposure. It also decreases motility in the adult mouse whipworm, Trichuris muris, prevents hatching and development of the dog hookworm, Ancylostoma caninum, and kills the blood fluke flatworm, Schistosoma mansoni. [90] However, someone who has taken doses of either 100 mg or 150 mg of Zoloft daily for 1.5 years has reported continuing benefits from his NA. [91]

    Antifungals [92]

    ✅ Safe antifungals unless marked otherwise

    The following appear to be safe for use with human helminths

    • fluconazole (Diflucan and Trican)
    • nystatin (Mycostatin, Nilstat, Nystop, etc.) This has been used for many years by one hookworm host without harming his worms. [93]
    • the fatty acid caprylic acid also appears safe [94]. However, anyone with a coconut allergy/intolerance should note that caprylic acid is a coconut/palm kernel derivative.
    • the enzyme-based anti-Candida product candex is also worm-safe. One hookworm host took 4 Candex capsules twice a day for over a month without any obvious harm to his worms. [95]
    • Sodium butyrate is a powerful antifungal that inhibits pathogenic yeast growth [97]. It is available as a food supplement and is also manufactured in the human intestines by the fermentation of vegetables. The bacteria responsible for butyrate production are vulnerable to antibiotics, but can be reintroduced, or supplemented, by means of fecal microbiota transplants (FMT), or the addition of the butyrate-producing bacterial species, clostridium butyricum, which generates butyrate directly in the gut. C. butyricum is available as the probiotic, Miyarisan Tablets [98], in Japan, and is available online, e.g., from eBay, [99] and in the probiotic formulations, Bifilac and Bifilac HP [100], the first of which is available from here. C. butyricum is also available as an animal feed additive [101]. Nutrients that help to increase butyric acid concentrations in the colon include pectin [102] and larch arabinogalactan [103], which is available as a supplement[104], although arabinogalactan can worsen rheumatic conditions. [105], [106]
    • Ascorbic acid (vitamin C) may interfere with the yeast-to-hypha transition [107] of candida.
    • Apple cider vinegar. Only a single individual has ever reported believing that apple cider vinegar had an adverse effect on their hookworm colony. [108] Since many other hookworm hosts drink apple cider vinegar without issue, [109] it can be considered to be worm-friendly. It has been revealed as a possible treatment for Candida species involved in denture stomatitis, [110] and there have been suggestions that, if ingested, vinegar might induce the body's gut defence system to help combat a Candida albicans infection. [111] Advice on using apple cider vinegar as part of an anti-Candida treatment regimen can be found here.
    • Iodine appears to have antifungal properties, is worm-friendly, and has proved effective against Candida for one hookworm host.[112]
    • Vitamin D turns on genes that make antimicrobial peptides, including cathelicidin [113], which has been shown to kill Candida. However, dosage with this vitamin may be critical, and excessive amounts might be counter-productive [114]. Aiming for the optimum blood level [115] of vitamin D would therefore appear to be ideal. (Vitamin D3 has been shown to extend the median lifespan of one species of roundworm by 30-40%. [116])
    • Some foods [117], eaten in normal dietary amounts, may help support an anti-Candida programme, but see the separate notes on ⚡cayenne, ⚡coconut and ⚡ginger. Fresh ✅ garlic may be particularly helpful [118], and dietary forms of garlic are known to be worm-safe, but see the details in the separate entry for garlic.
    • When Candida is a problem, very low carbohydrate (VLC) diets are best avoided because these cause ketosis, and yeasts love ketones.
    • Monolaurin (also known as glycerol monolaurate, glyceryl laurate or 1-lauroyl-glycerol). Monolaurin is a monoglyceride - the mono-ester formed from glycerol and lauric acid. Shown in test tube studies to have antibacterial and antiviral activity, it is commonly used as a surfactant in cosmetics, including deodorants, and as an emulsifier in foods. While it is active against candida [119], one subject has reported that taking two teaspoons of monolaurin daily, for a few weeks, produced no obvious effect on his worms. [120] [121] Another believes that she probably ingested a significant dose of monolaurin by drinking full fat coconut milk daily, but that her hookworms and whipworms both survived this. [122] Others have also confirmed that monolaurin is worm-safe. [123] [124]

    A very worm-friendly way to reduce Candida is to brush one's teeth after every meal instead of just once each day. This has been shown to reduce the abundance of C. albicans in the stool by 10-fold to 100-fold. [125] The addition of regular oil pulling using coconut oil (not to be swallowed) could further reduce the amount of candida. [126]

    ❓ More antifungals

    • ❓ Cellular silver (see Alternative therapies section). The manufacturers of Advanced Cellular Silver (ACS) 200 Extra Strength [127] claim that this product achieves a 99.9989% kill against C. albicans. Although there have been no reports to date of its possible effect on human helminths, its similarity to ➿colloidal silver (see Alternative therapies section) suggest that it may not kill the worms but only cause a temporary reduction of benefits.
    • ❓ Lactoferrin (also known as lactotransferrin [LTF]) is found naturally in secretory fluids, such as milk, saliva, tears and nasal secretions. It has antibacterial, antiviral, antifungal and antiparasitic properties, and is effective against candida. It’s antimicrobial properties are enhanced by the peptide, ❓lactoferricin, the anti fungal effects of which exceed those of lactoferrin. However, there have been no reports of any adverse effect on helminths, and one NA host has reported that taking 300mg of lactoferrin per day had no obvious effect on his worms. [128]
    • ❓ Lavender has antifungal activity and may be of value in treating candida. [129]

    Whilst polygodial has been shown to be effective against single-celled parasites such as protozoa, the only report so far that it might also have an adverse effect on helminths comes from a hookworm host who suspects that she killed her colony by taking Kolorex, which contains a mixture of horopito and ⚡aniseed.

    • ❓ Undecylenic Acid. This is the common name for 10-Undecenoic Acid, which is used in the Thorne Research product, Formula SF722. It is a potent antifungal mono-unsaturated fatty acid extracted from coconut and the castor bean. It has been shown to be 11 times stronger than caprylic acid, and is also claimed to have antiparasitic properties, although there have been no reports about this from hosts of therapeutic helminths.

    • ❌ Black cumin (nigella sativa). Also known as blackseed, black seed, black caraway, fennel-flower, nutmeg flower, Roman coriander, kalonji and 'Love in the Mist'. Extracts of this herb have shown antifungal effects [133] against different strains of Candida albicans, but it has also been used as an anthelmintic since ancient times. In India, today, nigella seeds are combined with various purgatives to help kill and expel intestinal parasites, and they have a synergistic effect with pharmaceutical anthelmintics. [134]
    • ❌ Gymnema sylvestre is effective against candida [135], but hydroalcoholic extracts of this herb have been found to have anthelmintic activity against the Indian earthworm, Pheretima posthuma. [136] Even though the research worm, C. elegans, appears to be unaffected by gymnema [137] and there are genetic similarities [138] between C. elegans and N. americanus, one helminth host suspects that gymnema was responsible for the loss of his hookworm colony.
    • ❌ Lufenuron is a benzoylurea pesticide used on crops and in veterinary medicine (in flea control, heartworm treatments and other anthelmintic products). Its powerful anti-fungal effects may be due to its ability to inhibit the synthesis of chitin, which is unfortunately an important constituent of the mouthparts of the hookworm.

    Some herbal antifungal products may adversely affect helminths, especially if they are in a concentrated form, so any herbal medicine that claims to have antifungal properties should be approached with caution.

    Some foods are coated with edible films containing antifungal compounds such as ❓natamycin (pimaricin) and ❌ oregano oil (see Oregano reference) but the quantities used in this application are probably insufficient to affect helminths, and there is no evidence [139] to date that natamycin harms intestinal flora.

    NB. Prolonged treatment with antifungal drugs can disrupt commensal fungal populations and cause an increase in the severity of disease states, as seen in one study [140] in acute and chronic models of colitis and allergic airway disease.

    Antihistamines

    Antihistamines as marked

    Benadryl products sold in the UK all contain drugs with anthelmintic potential - either

    • ✅ Cromoglicic acid (cromolyn, cromoglycate or cromoglicate, sodium cromoglicate [Nalcrom] or cromolyn sodium, plus Gastrocrom and Intercron) This is a mast cell stabiliser which prevents the release of histamine from mast cells and is used to treat some allergic conditions. One hookworm host has taken 8x100mg capsules of Nalcrom daily for periods of up to 10 days without any adverse effect on her colony. [141]
    • ⚡ Doxylamine (Bendectin, Debendox, Diclectin, Diclegis, Dozile, Lenotan, Merbental, Restavit, Unisom, Valocordin-Doxylamine, Vicks Formula 44 and Vomentin, etc.) One hookworm host believes that an unexpected return of gut symptoms and dry skin may have been caused by taking a quarter of a tablet of this first-generation antihistamine every night for a couple of weeks. [142] Another NA host believes that taking diclectin (doxylamine combined with pyridoxine) put her worms out of action until she stoped taking it. [143]
    • ⚡ Ketotifen - This antihistamine and mast cell stabilizer, which has similar effects to cromoglicic acid (see separate listing), is sold under a large variety of trade names [144] that include Allerban, Allergan, Bentifen, Ketasma, Mastifen, Zaditen and Zylofen. In one study using the helminth, Trichinella spiralis, the addition of ketotifen resulted in a greater worm burden and worm size, [145] but in a small in vitro test, one hookworm self-treater found that exposing a sample of NA larvae to Naziden left them “a bit lethargic but alive” [146] and they were still alive the next day. [147] However, effects in vivo don’t always correspond with those observed in a petri dish, and ketotifen is a piperazine-related substance so it may have an adverse effect on human helminths in vivo in at least some users.
    • ⚡ Promethazine (Phenergan, Promethegan, Romergan, Fargan, Farganesse, Prothiazine, Avomine, Atosil, Receptozine, Lergigan, and, in the UK, Sominex). This does not appear to kill helminths, whether taken orally or by intramuscular injection, and one self-treater who needs to take oral Phenergan daily says that her NA are unaffected. [148] However, another hookworm host has reported that this drug did reduce his worm benefits when it was taken orally.

    Piperazine related antihistamines

    Popular antihistamines derived from, or closely related to, the anthelmintic drug ❌ piperazine (See the separate entry for piperazine). These include:

    • ⚡ cetirizine (Zyrtec, Reactine)
    • ⚡ levocetrizine (Alcet, Allear, Curin, levcet, Seasonix, T-Day Syrup, Teczine, UVNIL, Vozet, Xaltec, Xozal, Xuzal, Xusal, Xyzal, Zilola, Zyxem)

    • ⚡ phenylephrine Some nasal decongestants and allergy medications contain this drug (e.g., products branded "Sudafed PE", but not those branded "Sudafed") so check the ingredients of the product you are considering using. While one hookworm host has reported using this drug without any adverse effect on her colony, [149] it does appear to have anthelmintic properties [150] and has been reported to have caused a brief return of disease symptoms in one hookworm host after a single dose.
    • ⚡ desloratadine (NeoClarityn, Claramax, Clarinex, Larinex, Aerius, Dazit, Azomyr, Deselex and Delot)
    • and possibly ⚡ acrivastine (Semprex-D in the US)

    While some people have taken cetirizine, levocetirizine or desloratadine concurrently with helminthic therapy - sometimes for very long periods - and had no loss of benefit from their worms (for example [151], [152]), there have been others who have suspected that these drugs have been responsible for adversely affecting or even killing their worms.

    Less common antihistamines derived from, or related to ❌piperazine. At the present time, there is no indication whether or not most of the following drugs could affect human helminths.

    • ❓ buclizine
    • ❓ chlorcyclizine (Di-paralene, Mantadil, Pruresidine, Trihistan)
    • ❓ cinnarizine (Stugeron, Stunarone, R5)
    • ✅/⚡ Hydroxyzine (Atarax, Vistaril, etc.) A parent has reported that her son’s NA were not harmed by taking this drug, but dose size and length of use in this case are not known. [153]
    • ❓ cyclizine
    • ❓ meclizine (Bonine, Bonamine, Antivert, Postafen, Sea Legs)
    • ⚡ dimenhydrinate See dimenhydrinate reference.
    • ❓ niaprazine
    • ❓ bilastine (Bilaxten) One NA host has reported that she had been taking bilastine on and off for 3 years - the same amount of time that she had been hosting NA - because she has found it to be very effective for her allergies, and, while the NA have sometimes seemed to be working during this time, they have mostly seemed not to be working all that well. However, she had been able to grow more NA consistently for 2 of the 3 years, thus confirming that she still had some worms, but, when she last reported her experience, she had stopped taking the Bilastine to see whether the NA work better in its absence. [154]

    ✅ H2 antagonists are safe

    H2 antagonists are a separate class of drugs from proton-pump Inhibitors (see separate section).

    The term, “antihistamine” is usually reserved for H1 antagonists whose main therapeutic effect is mediated by negative modulation of histamine receptors, but H2 histamine receptor antagonists can also be considered to be a type of antihistamine. H2 antagonists include

    • ranitidine (Zantac) which works by blocking histamine and thus decreasing the amount of acid released by the cells of the stomach.

    Other common H2 antagonists are

    • cimetidine (Tagamet)
    • famotidine (Pepcid) One hookworm host used this drug successfully, without harm to his colony, for at least 2 months, starting with 20mg daily and titrating within a month to 3x20mg per day. [155]
    • nizatidine (Axid, Tazac).

    Antimalarials

    • ⚡ Chloroquine A cross-epidemiological study of the effect of treatment for malaria in hookworm-endemic areas found that treated patients presented with reduced helminth egg burdens and worm-related pathology, [156] and a reduced hookworm egg count has also been reported in another set of subjects taking chloroquine. [157]
    • ✅ Hydroxychloroquine (Plaquenil, etc.) There has been one tentative suggestion from a helminth self-treater that this antimalarial medication, might have harmed her hookworms, but several others have taken this drug without any adverse effect on their worms. One took Plaquenil for 5 years without harming his NA, [158] another takes 400 mg daily without any adverse effect on her hookworms, [159] and two further subjects who have taken this drug, one of them in quite large quantities, had no issues with their worms. (Link expired)

    No other antimalarial drug has been suspected by self-treaters of harming therapeutic helminths, including Quinine.

    Antiprotozoals

    • ❌ Metronidazole (Flagyl). This is one of three derivatives of ❌nitroimidazole that is used against anaerobic bacterial and parasitic, as well as protozoan, infections. One hookworm host has reported[160] losing her colony to this drug, which should never be combined with mebendazole due a risk that, together, they may cause Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis, something about which many doctors and pharmacists may be unaware, especially in the US.

    Antipsychotics

    • ❌ Chlorpromazine (Thorazine and Largactil, etc.) This antipsychotic medication has shown anthelmintic effects against three widely divergent helminth species. It kills C. elegans at multiple life stages and acts rapidly to inhibit its feeding within minutes of exposure. It also decreases motility in the adult mouse whipworm, Trichuris muris, prevents hatching and development of the dog hookworm, Ancylostoma caninum, and kills the blood fluke flatworm, Schistosoma mansoni. [161]

    Antivirals

    (Also see Natural antivirals for effective worm-safe antiviral treatments.)

    • ✅ Famciclovir (Famvir) -- One hookworm host took Famciclovir (500mg) 3 times per day for many months without any noticeable effect on her colony. [162]
    • ✅ Nirmatrelvir / ritonavir This co-packaged medication, which combines two protease inhibitors and is marketed as Paxlovid, is used as a treatment for Covid‑19. There have been no reports of it harming human helminths and one report that it did not harm one self-treater’s NA colony. [163]
    • ✅ Valaciclovir/valacyclovir (Valtrex, Zelitrex) -- This antiviral drug was taken by one worm host for a week without any adverse effect on his hookworms or whipworms.
    • ❌ Nitazoxanide (See separate entry under Anthelmintics)

    Immunoglobulin therapy (IVIG)

    ✅ Immunoglobulin therapy, also known as normal human immunoglobulin (NHIG) is compatible with helminthic therapy and has been used effectively in combination with TSO. There is no reason to think that it would harm human helminths.

    Immunosuppressive drugs

    ✅ Immunosuppressive drugs reported to be safe for use by hosts of human helminths are:

    • cyclophosphamide (Sold as: Cytoxan, Lyophilized Cytoxan, Endoxan, Neosar, Procytox, Revimmune and Cycloblastin). This has been used repeatedly by one hookworm host who has reported that it had no adverse effect on her colony.

    It can be an advantage to be taking one of these drugs in the early stages of helminthic therapy because they can reduce, or even prevent, the transient side effects triggered by helminths, and their anti-inflammatory action can also help human helminths to become established. So anyone who is already taking one of these drugs should resist the temptation to stop taking it too soon after starting HT.

    This applies particularly to subjects with Crohn's and other intestinal diseases, who tend to have a very vigorous immune response to helminths. Suddenly withdrawing a drug that has been keeping this response in check will likely cause a rebound effect that could result in a flare and, potentially, a loss of worms. This is explained in more detail here.

    Immunotherapy

    ✅ Allergen immunotherapy -- In the form of sublingual drops/tablets, subcutaneous injections, and allergy “shots”, this is safe to be used concurrently with helminthic therapy. In fact, many who have used the two therapies together have been very pleased with the combined effects.

    Laxatives

    Hookworms are usually able to withstand the typical colonoscopy prep using products such as polyethylene glycol (PEG), Macrogol, Colyte, Picosalax, Bisacodyl, phospho soda, sodium picosulfate, or sodium phosphate and/or magnesium citrate. Many hookworm hosts have used the standard colonoscopy bowel prep without any problems (e.g., [167]), and there has only been a single report claiming that colonoscopy prep had terminated a hookworm colony. [168] However, another NA host has reported that, while a colonoscopy prep didn't entirely wipe out his colony, it appeared to have weakened it because he found a much smaller number of larvae than usual when he next incubated. [169]

    It is unlikely that laxatives would dislodge human whipworms once these are mature and embedded in the colonic mucosa, but laxatives could potentially flush them out before this, especially around 21-22 days post inoculation. It may therefore be best to avoid the use of laxatives around this time. After 28 days, human whipworms should not be affected at all.

    Also see Diarrhoea/diarrhea.

    Recreational drugs

    ❌ Piperazine-based recreational drugs

    Piperazine-based recreational drugs are a group of stimulant drugs with similar effects to ecstasy. (See separate entry for details on piperazine) The main piperazine-derivatives that have been used for recreational purposes include

    • BZP (Benzylpiperazine, A2, Frenzy, Nemesis)
    • TFMPP (1-[3-(trifluoro-methyl) phenyl]piperazine)
    • mCPP (meta-chlorophenylpiperazine, 1- [3-Chlorophenyl]-piperazine).

    These drugs were frequently mixed with caffeine and a range of vitamins and binders to make party pills that were marketed as “natural” or “herbal” highs, but were actually purely synthetic. Other piperazine-derived designer drugs include:

    • AcBZP (4-Acetyl-1-benzylpiperazine, AceticBenzylPiperazine)
    • MBZP (1-methyl-4-benzylpiperazine)
    • 2C-B-BZP (4-Bromo-2,5-dimethoxy-1-benzylpiperazine) One user has reported that periodic use of 2C-B did not affect his colony of NA.
    • DBZP (1,4-Dibenzylpiperazine)
    • MDBZP (3,4 Methylenedioxy-1-benzylpiperazine)

    ⚡ Yage (Ayahuasca)

    It has been opined that anything that enters the bloodstream and disorients a host has a potential to do the same to hookworms - since they feed on their host’s blood - and that, if the disorientation is excessive, it may cause the worms to lose their grip on the mucosa and possibly be flushed away from their home base in the small intestine, and be lost. Although the assumption that the worms will become inebriated by anything that inebriates their host has been questioned because the 'nervous system' of helminths is quite different from that of mammals, one recreational drug that might produce this effect and cause the loss of hookworms is the South American drug, yage, also known as ayahuasca, as well as by a number of other names. [170]

    This psychedelic brew, which is concocted by combining a variety of plant materials, was used as part of S. American native religious rituals and, since being commercialised, has become much more mainstream. Available in Europe and N. America through "churches" set up for its import, this drug causes a deep and immersive hallucinogenic experience during a “trip” lasting 4-8 hours, or 12-18 hours if the subject is re-dosed, which is not uncommon.

    "Its purgative properties are important (known as la purga or "the purge"). The intense vomiting and occasional diarrhea it induces can clear the body of worms and other tropical parasites [171] and harmala alkaloids themselves have been shown to be anthelmintic. [172] Thus, this action is twofold; a direct action on the parasites by these harmala alkaloids (particularly harmine in ayahuasca) works to kill the parasites, and parasites are expelled through the increased intestinal motility that is caused by these alkaloids." [173]

    “Tropical plants used by South American natives produce an array of isoquinoline and tryptamine-related alkaloids that are not only hallucinogens, but powerful emetics with a wide range of other biological activities, in particular antimicrobial and anthelmintic properties… We propose that these alkaloid mixtures were initially discovered and developed by indigenous people for treatment of a variety of parasitic diseases and incorporated into religious ceremonies using psychoactivity as an effective dose marker.” [174]

    However, in spite of all this evidence for the antiparastic potential of ayahuasca, one hookworm host has noticed no apparent adverse effect on her worms as a result of taking part in more than 10 ayahuasca ceremonies. [175] [176] Another helminth host has confirmed anonymously that he was able to culture more NA from his colony after participating in 3 ceremonies in one year.

    ✅ Safe for human helminths unless marked

    • Betel leaves -- The leaves of the Piper betle vine (part of the Piperaceae family, which includes pepper and ⚡kava) are used as a mild stimulant and are thought likely to be safe for human helminths, although there have been no reports from helminth hosts to confirm or contradict this.
    • ❌ betel nut (or areca nut) seed of the areca palm (and also known as the areca nut palm, betel palm, Pinang palm and Indian nut) is often chewed wrapped in betel leaves - a combination known as paan that is used for its stimulant and psychoactive effects. Betel nuts contain the anthelmintic arecoline and have been used as a tapeworm remedy. Fresh betel nuts are also known to be used very effectively by Torres Straight Islanders as a treatment for all types of intestinal worm, and surveys have found that the betel chewers were almost all worm-free, while others weren't. (Prolonged use of the betel nut can create addiction and the World Health Organization classifies the betel nut as a carcinogen.)
    • Cannabis, marijuana and hashish appear to be worm-friendly.
      A paper published in 2015 [177] showed that, in the group of hunter-gatherers studied, those who consume cannabis have a significantly lower rate of helminth infection, from which the researchers concluded that the Aka foragers must consume cannabis to kill parasites, even though the scientists admit that, while cannabis kills worms in a petri dish, it has not been shown to kill worms in animals. A different explanation for the correlation seen in this study could be that those individuals with the most worms feel less need to smoke cannabis, and this ties in with the experience of the many helminth hosts who have seen a reduction in anxiety while hosting worms.
      One host of both hookworms and human whipworms has confirmed the presence of eggs from both species after cannabis use, and another hookworm host who used 10 drops of hemp CBD (cannabidiol) oil twice daily, plus a few drops of THC (tetrahydrocannabinol) oil to help with sleep, has reported that her hookworms were unaffected. [178] Someone else used CBD oil for several months and noticed no adverse effect on his hookworms, [179] and this lack of any adverse effect has been confirmed by numerous other cannabis users. [180] [181] It has even been shown that CBD extends the lifespan and arrests age-associated physiological decline in the research nematode, C. elegans, so may potentially be beneficial for the health of other helminths. [182]
    • Cocaine, in its pure, unadulterated state, could be added to this list of worm-safe drugs, but it is commonly adulterated with other substances that might harm helminths, particularly ❌ levamisole which, according to one report, is the most popular bulking agent found in 73% of seized coke. [183]
    • ❓ Kratom (aka kratum and ketum). [186] [187] Extracts and leaves of kratom are reported to have been used as intestinal deworming agents in Thailand, and the FDA has warned consumers not to use any products labeled as containing kratom. [188] However, one human whipworm host has taken small doses without any apparent effect on his worms [189] and a hookworm grower has reported no reduction in yield from his cultures after he took kratom.
    • Opium and heroin (aka diacetylmorphine, diamorphine and other names) appear to be worm-friendly.

    Most other recreational drugs should be safe for use by helminth hosts, including tobacco, nicotine and most forms of alcohol.

    • ➿ Alcohol -- Normal social drinking should not have any adverse effect on helminths, however, alcohol acts as an antimicrobial, and substances produced by the death of gut bacteria can enter the bloodstream to cause inflammation and allergic reactions [190] which can temporarily make it appear as though therapeutic helminths have stopped working. Overindulgence in alcohol may therefore cause a temporary reduction in worm benefits in a dose-dependent manner. Excessive consumption of alcohol that results in the user going into a coma due to alcohol poisoning may incur a greater risk to helminths.
      • ❓ Absinthe is one alcoholic drink that might present more of a risk, as it was traditionally made using herbs reported to have antiparasitic properties, including ❌wormwood. (See separate entry). However, the risk from absinthe has been questioned because it only contains the essential oil of wormwood, while the anthelmintic activity of this herb has been linked more to the bitter principles and the alkaloids, which are not included in absinthe.
    • ❓ MDMA (ecstasy) -- As primarily a serotonin and dopamine agonist, this is thought unlikely to have much effect on helminths. However, serotonin agonism increases peristalsis, so using MDMA may not be a good idea until after the worms have attached to the intestinal mucosa. Once they are attached, the increased peristalsis alone would not dislodge them. One hookworm host has reported that he has twice rolled with MDMA and it didn't kill his worms. [191]
    • DMT (N,N-Dimethyltryptamine or N,N-DMT) This psychedelic compound with powerful hallucinogenic effects has been reported by one user to be safe for use with NA.
    • ❓ LSD (Lysergic acid diethylamide) is unlikely to harm helminths, and there has been one report to confirm this.
    • ❓ Myristicin -- This psychoactive drug, which is the traditional precursor for the psychedelic and empathogenic drug MMDA, is found in very small quantities in vegetables, herbs and fruits consumed by humans on a daily basis, e.g., parsley, celery, lemons, figs, carrots, grape juice, nutmeg and dill, but this dietary intake is unlikely to be harmful to helminths. [192]
    • ❓ Peyote (Lophophora williamsii) -- This cactus, which contains psychoactive alkaloids, including mescaline, is thought unlikely to harm helminths, but there have been no reports to confirm this.
    • ❓ Psilocybin, a substituted tryptamine, is a naturally occurring psychedelic compound produced by more than 200 species of mushroom. Although illegal in most countries/states, psilocybin is used for the self-treatment of cluster headaches and one hookworm host has reported using this compound for two months to treat severe migraines, without noticing any apparent effect on his worms. However, it is possible that higher doses of this hallucinogenic may disorient hookworms for long enough to cause their loss.
    • Rapé (pronounced “ha-peh”) is a powerful snuff originally used by shamans in Brazil and Peru as part of medicinal rituals. This sacred tobacco has increased in popularity outside of the Amazon during the early twenty-first century for its medicinal properties, and two hookworm hosts have reported using rapé without adversely affecting their colonies. [193] [194]

    Vaccines

    Three helminth hosts have claimed that they may have lost their hookworms after receiving the ⚡ tetanus vaccine, although others have had tetanus shots without any loss of worms, and several people receiving flu vaccination have reported that this had no effect on their hookworms. [195] [196] Nothing has been reported in respect of other vaccines. Also see Helminthic therapy and vaccines.

    Miscellaneous pharmaceuticals and chemicals

    ✅ Safe for worms unless marked otherwise

    • ❓ Aciclovir (Cyclovir, Herpex, Acivir, Acivirax, Zovirax, Zoral, Xovir and Imavir). There have been no reported problems with this drug so far. See also the related drug, Valaciclovir/valacyclovir.
    • ❌ Bacillus thuringiensis (Bt) is a soil bacterium that has been engineered into food crops such as corn and rice to render them pest resistant, and residues of Bt-based insecticides have been found on fresh fruits and vegetables. [197] Cry5B, a pore-forming protein produced by Bt can kill intestinal worms and is highly effective against all hookworm species tested in all models [198]. It is also used as a natural insecticide on crops on some organic farms. However, the risk of therapeutic helminths being killed as a result of their hosts ingesting small amounts of the delta endotoxins produced by Bt is likely to be very low. When used as an insecticide, one of the many Bt strains available is selected for its specific toxicity against the target insect. The strains that produce toxins against nematodes are therefore unlikely to be used as agricultural insecticides. In addition to this, the toxins produced need to be ingested by the target organism to become active and, as proteins, they may be denatured by heat during cooking. [199] The probiotic bacterium, Bacillus subtilis, can also be engineered to express the Cry5B protein, a small dose of which has been shown to kill intestinal nematode parasites, achieving a 93 percent elimination of human hookworms in hamsters. [200], [201] Although researchers may be pursuing this development as a means of delivering anthelmintics via foods and food supplements, the strain of Bacillus subtilis currently used in probiotics that have been manufactured for human consumption is not known to have been modified in this way, and one hookworm host has reported that his worms were unaffected after eating a lot of natto (made using Bacillus subtilis) and taking the Bacillus subtilis-containing probiotic product, Megasporebiotic. [202]
    • Baclofen (Kemstro, Lioresal, Liofen, Gablofen, Beklo and Baclosan) is a derivative of gamma-aminobutyric acid (GABA). One host who took 20-30mgs of baclofen daily reported no loss of worm benefits.
    • ❌ Barbiturates have now largely been replaced in routine medical practice by ✅ benzodiazepines, but they may still be encountered in general anaesthesia, for epilepsy, and in the treatment of acute migraines. These drugs depress the central nervous system, producing effects ranging from mild sedation to total anaesthesia, so, taken in sufficient quantity, they may disorient hookworms sufficiently to cause them to lose their grip on the intestinal mucosa and be flushed away from their feeding site.
    • Benzodiazepines (BZD, benzos). There have been no reports of this type of drug having any adverse effect on helminths. The short-acting anti-anxiety drug, alprazolam (Xanax), was taken by one hookworm host (0.5 mg 3 or 4 times over the course of a month) without any apparent effect on his worms. [203], [204] Other self-treaters have found that clonazepam (Klonopin) [205] and lormetazepam are both worm-safe, as is Lorazepam (Ativan). [206]
    • ❓ Bismuth subsalicylate (pink bismuth, the active ingredient in various stomach-settling medications such as Pepto-Bismol and Kaopectate)
      There has been one suggestion that bismuth may have a temporary adverse effect on human helminths, similar to that caused by local anaesthetics/anesthetics, but this has not been confirmed by others. Pepto-Bismol is listed as containing aspirin (acetylsalicylate) or an aspirin-like substance (see ✅ Anticoagulants section regarding this ingredient).
    • Bisphosphonates This class of drugs appears to be harmless to human helminths. They are used to prevent the loss of bone density, and include zoledronic acid (aka zoledronate, sold under brand names such as Reclast, Zometa, Zometa Concentrate and Aclasta). One NA host has had two infusions of Aclasta without issue. [207]
    • ❓ Calcium channel blockers (CCBs), also known as calcium channel antagonists or calcium antagonists. These medications, which disrupt the movement of calcium through calcium channels, and are commonly used to treat cardiovascular diseases including hypertension, have also shown activity against the non-therapeutic helminth, Schistosoma mansoni. And it has been suggested that the calcium blocking effect of these drugs might be exploited to enhance the effect of existing anthelmintic drugs, or to produce new ones. [208] While there have been no reports thus far of therapeutic helminths being affected by calcium channel blockers, this remains a theoretical possibility.
    • Carbamazepine (Tegretol, Equetro). This appears to be worm-safe. One host who took this for two weeks was still producing ample hookworm ova at the end of this period.
    • Chlorine. As a constituent of chlorinated water, e.g., municipal water supplies and at swimming baths, this is no threat to helminths.
    • ❓Chlorine dioxide (CD, also known as MMS, CDS, CDH) is an industrial disinfectant and bleach that is used in water purification and detoxification. CD has been taken orally by people who claim that it kills parasites, and that "rope worms" are often released during CD enemas. However, when these rope-like forms have been analysed, they have been found to contain mostly human DNA, so are likely to be merely pieces of gut lining.
    • Cortifoam, a hydrocortisone rectal aerosol, uses propane and isobutane as propellants, neither of which is known to have any adverse effect on helminths.
    • Cromoglicic acid (cromolyn, cromoglycate or cromoglicate, sodium cromoglicate [Nalcrom] or cromolyn sodium)
      is a mast cell stabiliser with anti-allergy effects. One hookworm host has taken 8x100mg capsules of Nalcrom daily for periods of up to 10 days without any adverse effect on her colony. [209]
    • ❌ Doxazosin Sold under brand names such as Cardura and Carduran, this antihypertensive medication has been found to have anthelmintic properties. [210] One hookworm self-treater had indications over a three year period that he had lost his NA colony: reappearance of pre-hookworm symptoms, eosinophil count down to "normal" and inability to incubate more larvae. Repeated re-inoculations with viable larvae failed to restore his colony, and he eventually realised that the loss of the worms had coincided with the change in antihypertensive medication, to the alpha-blocker, doxazocin. [211]
    • ❓ DMPS (Dimercapto-propane sulfonate/2,3-Dimercapto-1-propanesulfonic acid) and its sodium salt, Unithiol. There have been no reports so far about possible anthelmintic effects following the use of this drug, but there do appear to be some serious risks attached to its use.
    • DMSA (Dimercaptosuccinic acid, also called succimer). The meso isomer form of this organosulfur compound is used as a chelating agent for the treatment of heavy metal toxicity. One hookworm host has taken 25 mg DMSA every 3 hours around the clock for 5 days, and repeated this every 3 weeks for a year without harming her hookworm colony. [212] DMSA is apparently such an effective chelator that it may deplete levels of beneficial minerals, so should arguably be used under the guidance of a practitioner. [213]
    • DMSO (Dimethyl sulfoxide) has been used by two hookworm hosts without any adverse effect on their colonies. [214]
    • ❓ EDTA (Ethylenediaminetetraacetic acid). There are, as yet, no reports from helminth hosts about the possible effects on intestinal worms of this heavy metal chelator.
    • Essential oils. These are also known as volatile oils, ethereal oils, aetherolea, or simply as the oil of the plant from which they were extracted. Certain essential oils contain some of the most potent antimicrobial compounds available and can be considered to be natural antibiotics. For example ❌oregano oil (see Oregano reference) and ⚡peppermint oil (see Peppermint reference) can affect human helminths if ingested. However, small quantities of most essential oils should be safe for helminths when applied topically, since not all of the oil applied will reach the bloodstream. And when essential oils are diffused into the air using a nebuliser, heated over a candle flame or burned, these should not harm helminths, even when using blends containing oregano or peppermint oil. [215] [216] However, one hookworm host lost most of her colony when she walked into a room where a diffuser had been left running after a child had emptied an entire bottle of peppermint essential oil into it. She only took one breath in the room before leaving, but her home incubations fell from 25-35 larvae per droplet to just 1 larva per 3 droplets. And, many months and 3 inoculations later, she was still only getting 7-8 larvae per droplet. This inhalation of diffused peppermint oil also caused blistering burns to her face, nostrils and lungs, and did significant damage to her gut microbiome. [217] [218]
    • ⚡ GABA (gamma-aminobutyric acid). It has been reported [219] that the anthelmintic drug, ivermectin, causes paralysis in worms by increasing GABA, and a hookworm host has mentioned that she “used to do really well with GABA, but worms don't like it.” On the other hand, a child with Type 1 diabetes was given GABA (750mg x4 per day) alongside hookworm therapy without any indication that the worms were affected by this, and another hookworm host who took 20-30mgs per day of ✅baclofen (a derivative of GABA) reported no loss of worm benefits.
    • ⚡ Gabapentin (Neurontin). One hookworm host has taken this without any obvious adverse effect on her colony (link expired), and another has said that she was down from 1200mg to 600mg of gabapentin per day when she first discovered helminths and was never aware of it affecting her worms. [220] However, someone else has reported that single doses as low as 150mg "severely upset" his NA, and taking 3 doses in a row caused a complete loss of benefits for 4-5 days. [221]
    • ❌ Genistein is an isoflavone (phytoestrogen) with antioxidant and anthelmintic properties that has been found to be the main substance responsible for the deworming activity of the root-tuber peel extract of Felmingia vestita, the plant traditionally used as an anthelmintic by the Khasi tribes of India. Genistein is a potent cestocide, being highly effective against several species of tapeworm, as well as a pork trematode and a sheep liver fluke. (See also: [222]) Given the strength of its effect against these other helminths, it is reasonable to assume that concentrated or synthesised forms of genistein (such as KBU2046 and B43-genistein) may also harm or even kill therapeutic human helminths, although there is no evidence that eating soy products might be harmful to human helminths as a result of the naturally occurring genistein they contain.
    • Guaifenesin. This oral expectorant and muscle relaxant is sold under various brand names, including Mucinex, and is added to many other medicines. There have been no reports of this drug having any ill effect on helminths, and one hookworm host has reported that he regularly takes between 2 and 6 x 400 mg guaifenesin tablets to treat congestion, without any apparent effect on his worms. Another NA user reports continuing to use high doses without issue. [224]
    • Helium appears to be worm-safe, based on the experience of one hookworm host who deliberately inhaled a small volume of the gas (to enjoy the timbre-changing effect on his voice!) while blowing up balloons, and had no loss of effect from his worm colony.
    • Hydrogen therapy. One NA host has reported that inhaling hydrogen gas and drinking hydrogen-infused water has not harmed his colony. (Link expired.)

    • Hydrogen peroxide (H2O2). This may kill helminths in a petri dish but it is so highly reactive that, if ingested, there is likely to be little left by the time it reaches the stomach. And, when inhaled, H2O2 stays largely within the lungs, with only a small amount reaching the blood. Since the amount that could be transmitted to helminths is therefore negligible, it is thought unlikely that H2O2 would be a problem for any intestinal helminth, although no one has reported on this, one way or the other.
    • ❓Hyoscyamine [225]. (Also known as daturine and levo-atropine. Brand names include Symax, HyoMax, Anaspaz, Egazil, Buwecon, Cystospaz, Levsin, Levbid, Levsinex, Donnamar, NuLev, Spacol T/S and Neoquess.) It has been suggested that hyoscyamine is unlikely to be harmful helminths, [226] but there have been no reports to confirm this.
    • ❓ Isotretinoin (13-cis retinoic acid, Roaccutane, Accutane, Amnesteem, Claravis, Absorica, Isotroin and Epuris) is used to treat acne and other skin conditions. Although there have been no reports of harm to helminths as a result of taking this drug, anyone considering its use might appreciate knowing that it has been linked to autoimmune disease, which is of course what many readers of this website are already dealing with. The link is controversial, but this paper [227] sets out the facts.
    • Ketamine There have been no reports to suggest that ketamine might be harmful to human helminths, and one NA host has reported that an incubation following four 200 mg doses of this drug had yielded a bumper crop of larvae, confirming that the drug had had no adverse effect on her colony.
    • Lactulose. This synthetic, non-digestible sugar used in the treatment of chronic constipation and as a test for small intestine bacterial overgrowth (SIBO) has not been reported to have any untoward effects on human helminths.
    • ❌ Limonene This has been shown to have a comparable anthelmintic effect against adult Schistosoma mansoni as the common anthelmintic drug, praziquantel, [228] (Praziquantel has a 23% cure rate in hookworms. [229]) and one hookworm host has reported experiencing a return of disease symptoms after taking 500 mg of limonene daily for a week. [230]
    • Loperamide (Immodium, Lopex, etc.) This drug has been taken by numerous worm hosts and there have been no reports of it harming their worms.
    • Low dose naltrexone (LDN). This is compatible with helminthic therapy and several people have had good results from this combination, although the drug doesn’t suit everyone. More details here.
    • ❌ Mepacrine (quinacrine [Atabrine]). This is an antiprotozoal drug that has also been used against tapeworms, so it could harm hookworms and whipworms. No one has so far reported any problem with it, but it's likely that few, if any, helminth hosts will have taken it, especially as, "Mepacrine is not the drug of choice because side effects are common, including toxic psychosis, and may cause permanent damage."
    • ❓ Metformin [Glucophage], phenformin, and rosiglitazone [Avandia] are anti-diabetic medications (also known as oral hypoglycemic or antihyperglycemic agents) that have been shown to have antibiotic properties [232], so might therefore have some degree of anthelmintic effect when used in higher doses. However no reports of such an effect have been posted so far by hosts of therapeutic human helminths.
    • ⚡ Methotrexate. Some people have taken methotrexate alongside HT without any problem, including one NA host who combined these two treatments for 1½ years, taking up to 15 mg methotrexate per day. [233] [234] However, one individual got no benefit from his worms for over a year, while he was taking this drug.
    • Montelukast (Singulair, Montelo-10, Monteflo, Lukotas, Arokast and Pulmikast). This leukotriene receptor antagonist has been taken intermittently, in 10 mg doses, by one hookworm host with no apparent effect on her colony, [237] [238] and regularly by another. [239]
    • ❌ Muscle relaxants. There is a theoretical risk that anything that relaxes a hookworm host may have a similar effect on their colony, conceivably affecting the ability of their worms to maintain their grip on the host’s mucosa, and possibly resulting in their expulsion, although this effect would likely be dose-dependent. There has only been a single report of a possible adverse effect, in which a hookworm host suspected Carisoprodol (Soma, Sanoma and Carisoma) of causing the loss of his hookworm population, and both ✅Guaifenesin and a single night-time dose of 6 mg of ✅Tizanidine [240] appear to be safe. Whipworms are much less likely than hookworms to be affected in this way, due to them not feeding directly from the bloodstream and the fact that they anchor themselves deeply into the colonic mucosa, so are not easily dislodged.
    • ❓ Nintedanib (Ofev and Vargatef) is a piperazine drug (piperazine is an anthelmintic), so *may* have a harmful effect on NA, and to a lesser extent on TT. Unfortunately, there have been no reports about this drug, although the absence of any previous mention of it is a hopeful indication.
    • Oxymetazoline (Ocuclear and Drixine) This drug is available over-the-counter as a topical decongestant in the form of oxymetazoline hydrochloride in nasal sprays such as Afrin, Dimetapp, Dristan, Drixoral, Facimin, Mucinex Full Force, Nasivin, Nostrilla, Operil, Otrivin, Otrivine, Oxyspray, SinuFrin, Sudafed OM, Utabon, Vicks Sinex and Zicam. At least one NA host has used these sprays without any harm being caused to his worms.
    • ❓ Ozone. Ozone therapy is used as an alternative treatment for various diseases in humans but is still controversial. Ozone is also used to kill microorganisms, in some instances being employed in place of chlorine as a bactericide. It is also used to eradicate water borne parasites such as Giardia lamblia and Cryptosporidium, and to kill insects in stored grain. So there would appear to be a potential for ozone to have an adverse effect on human helminths, although this may depend on dosage and there have been no reports to date of the use of ozone by helminth hosts, so caution would seem to be warranted until more is known.
    • Paracetamol (acetaminophen. Also sold under names tylenol, panadol, etc). This is safe for use with helminths.
    • ❌ Pentobarbital (US), pentobarbitone (UK), e.g., Nembutal, is a short-acting barbiturate that has been used as a sleep aid, as well as to euthanise animals and to execute humans. It’s possible that the dosages used to encourage sleep might not have any deleterious effect on human helminths, but, if this drug were to disorientate hookworms, they could lose their grip on the intestinal mucosa and be flushed away. So far, there have been no reports about this drug from any helminth host, although few, if any, will have taken it.
    • ⚡ Piracetam. This nootropic, cognition- and memory-enhancing drug (Nootropil, Qropi, Myocalm, Dinagen) was suspected as the cause in one case of sudden worm loss.
    • ❓ Pregabalin (Lyrica) is a gabapentinoid drug about which the only report so far has been from someone who who had taken 3 doses of 25mg Lyrica daily for several weeks, with no issues for her NA. [242]
    • ❓ Prucalopride (DuphaPro, Prudac, Resolor, Resotran) This drug, which is used in the treatment of constipation has been reported by one hookworm host to have had a “pretty marked negative effect” on his worms.
    • Pseudoephedrine is a stimulant nasal decongestant [244] that is sometimes added to antihistamine preparations and other products, including some formulations sold under the Sudafed brand. Pseudoephedrine has not been reported to have any adverse effect on helminths.
    • ➿ Radioactive iodine (also known as radioiodine), which is used in the treatment of hyperthyroidism, can adversely affect hookworms, at least temporarily. One worm host found that isotope I-128 (used in diagnostics) put her colony out of action for a week or two, and has suggested that isotope I-131 (used to kill thyroid tissue) may have a similar effect.
    • Rhophylac The Rhophylac (anti-D immunoglobulin) injection, which contains human anti-D immunoglobulin, is given to pregnant women with rhesus negative blood type. One hookworm host has reported that her colony was unaffected by this injection. [245]
    • Sildenafil (Viagra). This does not kill hookworms.
    • Simeticone, also known as simethicone (Gas-X, Infacol, Wind-eze, WindSetlers, etc…), is an anti-foaming agent used in different dosages, and in combination with a variety of other drugs, to reduce the bloating, pain and discomfort caused by excessive intestinal gas. Simethicone has been tested directly on pig whipworm ova (TSO) and found to have no effect on them, and one hookworm host has reported taking simethicone periodically with no noticeable adverse effect on her worms. [248]
    • ❓Sirolimus (aka rapamycin, sold as Rapamune and Fyarro) This immunosuppressive medication was suspected by one NA host of having negatively impacted his worms for several weeks after he took a single dose of the drug.
    • Sodium oxybate (Xyrem, Alcover) is the sodium salt of γ-hydroxybutyric acid (GHB), which is unlikely to harm helminths because it’s an endogenous substance found naturally in the human body [249], and one hookworm/whipworm host has confirmed that it did not affect her worms. [250]
    • ❌ Turpentine. Also known as spirit of turpentine, oil of turpentine, wood turpentine and, colloquially, turps, this is distilled from pine tree resins. If applied topically to the skin - for example as a treatment for lice - it is unlikely to harm helminths. However, it has been used traditionally as an anthelmintic, so it may be harmful to human helminths if taken internally. It may also be toxic to humans!
    • Vicks First Defence. This cold preventative nasal spray does not contain antiviral chemicals, but forms a microgel that coats the lining of the nose to trap the cold virus and prevent this from reaching, and infecting, the cells within the nose. The microgel also reduces the pH inside the nose, which further helps by making it harder for the cold virus to multiply. It seems unlikely that any of this product’s ingredients [252] would harm helminths, although there have been no reports to confirm this.
    • Volatile Organic Compounds (VOCs), as found in paints, felt tip markers, etc., are unlikely to harm helminths. One helminth host who regularly worked with organic solvents (including CH2Cl2 and CHCl3) has reported that his helminths have not been affected.
    • Xylometazoline Also spelled xylomethazoline, and branded as Otrivin and Otrivine, etc., this decongestant drug is safe for use with human helminths. [253]

    Medical procedures

    ✅ Safe for human helminths unless marked otherwise

    • Colonoscopy As whipworms live in the colon, they may be at some risk of being struck by a colonoscope, but much of their body is embedded in the soft mucosa, and they are well lubricated with mucus, so few, if any, are likely to be damaged. Hookworms should not be affected by colonoscopy at all because they live in the small intestine, which is much higher up the GI tract.
      Hookworms might possibly be seen during a colonoscopy, but only if the colonoscope is advanced into the terminal ileum, and only then if any hookworms have taken up residence in the ileum, which is not common as they normally concentrate in the upper part of the jejunum, which is above the ileum, and is shown in red in this representation.

      mouth ➤ oesophagus ➤ stomach ➤ duodenum ➤ jejunum ➤ ileum ➤ caecum ➤ colon ➤ rectum

      Anaesthesia for colonoscopy is likely to involve the use of opioid pain killers (fentanyl, etc.), benzodiazepine anaesthetics (Versed, etc.) and/or narcotic analgesics, all of which appear to be harmless to helminths.
      See also Laxatives regarding colonoscopy prep.
    • Colon cleansing This will not harm hookworms and is unlikely to harm whipworms unless the fluid used contains something to which the whipworms are vulnerable.
    • Enemas These will not affect hookworms at all, and the liquid used is unlikely to have any adverse effect on whipworms unless this contains something to which they are susceptible.
    • Endoscopy A standard upper endoscopy (via the mouth) will not reach past the duodenum, and probably only as far as the second of the four parts of this section of the small intestine. It would therefore not harm hookworms or even allow a doctor to see the jejunum, which is the predominant location of hookworms by 20 weeks post-inoculation, shown in red in this representation.

      mouth ➤ oesophagus ➤ stomach ➤ duodenum ➤ jejunum ➤ ileum ➤ caecum ➤ colon ➤ rectum

      For information about the anaesthetics used during an endoscopy, see the general anaesthetics section.
    • Epidural opioid analgesia Opioids such as fentanyl are generally safe for helminths, and one hookworm host has reported that her colony was fine following epidural analgesia administered during labour. [257] If an anaesthetic is added to the epidural, the effects of this may be similar to those of other local anaesthetics. (See the local anaesthetics section).
    • Magnetic resonance imaging An MRI is unlikely to harm helminths, but it can cause a temporary adverse reaction in the patient which may overshadow the benefits being provided by their helminths. [258] The❓gadolinium-based contrast agents used for MRI may also have adverse effects on the patient, [259] and there has been one report by a hookworm host who had two MRIs using gadolinium within the same week and experienced a subsequent return of her disease symptoms. [260]
    • ❌ Radiation therapy (also known as radiotherapy, and abbreviated as RT, RTx, or XRT) is a treatment for cancer that used ionizing radiation. It had been thought unlikely that this would harm helminths [261] but one hookworm host appears to have lost her colony after radiotherapy for breast cancer. [262]
    • Radiology Radiological procedures (e.g., radiography using X-rays) and the contrast materials used in these (e.g., barium and gadolinium) have been found to be worm-safe by several hookworm users, [263], [264] but also see the comments about gadolinium in the previous entry, above, for magnetic resonance imaging.
    • Ultrasound At least two hookworm hosts have had ultrasound examinations without their colonies being affected. [265] [266]

    Alternative therapies

    Natural antibiotics

    • ➿ Colloidal silver. Some sources have claimed that, if taken orally, this may kill parasite eggs and possibly harm adult worms, but many helminth hosts have taken colloidal silver and there have been no reports of worms being lost as a result. Colloidal silver appears to be the most worm-friendly of the more effective natural antimicrobials, and it has also been shown to have no significant effect on the biodiversity of species in the gut microbiome. [267]. Although it can reduce helminthic benefits in a dose-dependent manner while it is being taken, the benefits soon return after its use is discontinued - usually in a matter of days. (Use of this Silver Safety Auto-calculator will ensure that total silver intake remains at a safe level.)
    • ❓ Cellular silver. The manufacturers of Advanced Cellular Silver (ACS) 200 Extra Strength claim that it is “...effective against an enormous array of disease causing organisms; literally oxidizing the cell wall of gram positive and gram negative bacteria, spirochetes, virus, fungus, parasites and more without harming healthy flora or damaging human tissue”. Research[268] shows that this form of silver may be more effective than ➿colloidal silver (see Colloidal silver, immediately above), but, so far, there have been no reports from helminth hosts to suggest what effect, if any, it might have on human helminths.

    • ⚡ Grapefruit seed extract (GSE). Also known as citrus seed extract and grapefruit seed oil, and often labelled as citrus seed oil. It is used in herbalism and natural therapies as an antibiotic and preservative, and is claimed to be a powerful broad spectrum bactericide, fungicide and antiviral that is effective against a large number of single-celled and multi-celled parasites. However, research has shown that many “natural” GSE products are adulterated with undeclared synthetic chemicals, commercially available preservatives and disinfectants, such as triclosan and benzethonium chloride. Some versions of GSE may not contain any authentic grapefruit seed extracts whatsoever, such that its sale may well be one of the most insidious herbal product scams ever. Even if genuinely pure, natural GSE could be found - which, given the evidence, seems doubtful - there may be little point in taking it as an antimicrobial because pure GSE has been shown to have no intrinsic antimicrobial action. And, as the makeup of proprietary GSE products varies so widely, these can not be recommended for worm hosts due to the possibility that one or more of the undeclared ingredients may harm human helminths. (NB. The flesh of grapefruit will not harm helminths.) Also see Grape seed extract, which is safe for use by hosts of human helminths.

    Natural antivirals

    ✅ Antiviral nutraceuticals that are safe for human helminths unless marked otherwise

    Vitamin C
    Taken in large quantities, vitamin C (ascorbic acid) has proved to be very effective against the common cold virus. When volunteers in one study were given 8 grams (8,000 mg) on the first day of a cold, 46% were cold free the next day. [269]
    In a study involving 700 students, those taking doses of I gram (1,000 mg) of vitamin C each hour for the first 6 hours and then 1 gram three times daily thereafter reported an 85% decrease in cold symptoms compared to those receiving conventional cold and flu treatment. [270]
    The ideal amount of vitamin C for colds or flu varies between individuals, but can be established in each case by taking ascorbic acid to ‘bowel tolerance’. Physicians have suggested starting with 3 grams immediately, then taking 1 gram each hour. Once this causes diarrhoea, the dose is reduced.
    In respect of the coronavirus, SARS-CoV-2, and the disease it manifests (COVID-19), see the following articles.
    One UK doctor recommends treating coronavirus with 10 grams of vitamin C in 500 ml of water every hour until the patient gets diarrhoea. [271]
    In March 2020, the government in Shanghai, China, officially began recommending high-dose intravenous vitamin C for the treatment of COVID-19. Dosage recommendations varied with the severity of illness, ranging from 50 to 200 mg per kg of body weight per day. [272] In the same month, hospitals in New York also began treating coronavirus patients with vitamin C. [273]
    Vitamin C dosing for children. Authorities on the use of vitamin C recommend dosing children by body weight, giving a proportion of the adult dose commensurate with the child’s weight as a proportion of the weight of the average adult. In one placebo-controlled study, the majority of subjects were infants and children under five years of age with severe pneumonia. They were given 200 mg vitamin C per day, which is equivalent to a modest adult dose of 2,000-3,000 mg per day. The authors of this study concluded that, even at this dose, "Vitamin C is effective in reducing duration of severe pneumonia in children less than five years of age. Oxygen saturation was improved in less than one day." [274] Also see, Vitamin C and Infants: Determining dose.
    Liposomal vitamin C. This form of vitamin C is absorbed by a different mechanism, in the gut. The liposomes containing vitamin C can bind directly to the gut cells to release their content of vitamin C which therefore does not require active transport. Thus the maximum level achievable with oral doses of liposomal vitamin C is higher than for regular vitamin C. However, since the absorption mechanism for liposomal vitamin C differs from the active transport of regular vitamin C, both forms can be taken together to increase the level in the bloodstream (up to 400-600 μM), greater than either oral form alone. (Levy TE (2011) Primal Panacea. Medfox Pub. ISBN-13: 978-0983772804)
    Vitamin D
    This vitamin acts as a natural antibiotic, working against every type of microbe, including viruses, bacteria, fungi and parasites, but it does not harm therapeutic helminths.
    The flu can be treated effectively with a 1-time dose of 50,000 IU vitamin D3, or with 10,000 IU 3 times daily for 2 to 3 days. [275]
    Some functional medicine practitioners advise that it is relatively safe to increase vitamin D intake to as much as 50,000 IU per day during times of virus exposure. John Cannell, MD, of the Vitamin D Council, suggests that 50,000 IU should be taken once each day for three days at the first sign of a cold or the flu. [276] David Brownstein, MD, recommends taking 50,000 IU per day for 4 days (link expired) and Dr Stephen Gundry suggests taking as much as 150,000 IU daily for 3 days to treat a respiratory infection. [277]
    Vitamin D supplementation produced a statistically significant reduction in the risk of COVID-19 infection and of the infection ending in death within 30-days. Patients receiving higher cumulative dosages and higher average daily dosages showed a greater reduction in COVID-19 infection rates than patients receiving lower dosages. "As a widely available, inexpensive, and safe treatment, vitamin D3 could be a helpful tool for reducing the spread of COVID-19 infection."
    Hydrogen peroxide (H2O2)
    Daily use, for 1 minute, of a 1% hydrogen peroxide solution as a mouthwash and throat gargle, and the daily use, for 1 minute, of a 0.5% solution as a nasal rinse, have been found to provide effective protection against SARS-CoV-2 infection. The fact that hydrogen peroxide is safe, inexpensive and readily available led this study’s authors to recommend it for the protection against COVID-19 of healthcare workers, inpatients and all vulnerable groups. And, since H2O2 used in this way will not be swallowed or inhaled, it should not harm helminths.
    Lysine
    Lysine appears to be highly suppressive of viral replication. Approximately 80% of acute stage Covid-19 patients given lysine displayed a minimum 70% reduction in symptoms in the first 48 hours. Treatment times varied from 2 days to 3.5 weeks (excluding long term symptomatic subjects), and patients who started lysine in the hospital were discharged an average of 3 days after starting treatment.
    Elderberry
    Eating elderberries and taking their extracts can help minimise influenza symptoms. [278] But note the following.
    • "Patients with autoimmune diseases like rheumatoid arthritis, celiac, hashimoto’s, and lupus need to consult a physician before taking elderberry because it will stimulate their immune system. Elderberry interferes with medications that suppress the immune system and medications used to treat autoimmune diseases.” [279]
    • While elderberry extract is considered to be effective against flu, it works, as many other immune boosters do, by increasing the cytokine response. [280] Since COVID-19 (aka SARS-CoV-2) kills primarily by initiating a cytokine storm, elderberry is probably best not relied upon as a stand-alone option against the new coronavirus, and, if used at all, would be best combined with one or more of the other effective anti-pathogenic treatments mentioned in this section.

    Other worm-safe nutraceuticals with antiviral effects

    • Virus-Specific nutraceutical and botanical agents listed by the Institute for Functional Medicine. [281] [282]
    "Thus, in light of the antiviral effect of ginkgolic acids (GA) on established viral infections of permissive cells, GA potentially could be used to treat acute viral infections (e.g. Coronavirus (COVID-19), EBOV, ZIKV, IAV and measles)."
    "It seems that antioxidants, especially vitamins C and D, selenium, and zinc, can improve multiple COVID-19 clinical outcomes."
    "… free fatty acids in fish oil may have potential as mouth/throat wash to reduce concentration of SARS-CoV-2 viruses in saliva and upper respiratory mucosa and reduce transmission."

    Plant medicines recommended for the treatment of coronavirus

    Inhaled treatments - safe for human helminths unless marked otherwise

    Iodine
    Iodine kills all single-celled microbes on contact and can be introduced into the airways by inhalation from a salt pipe or face mask, or via home-made iodine oil. [283]
    • Salt pipe. Two drops of Lugol’s iodine 12% or 15% dripped into the mouthpiece of a salt pipe (or simply applied to a piece of cotton wool) can be sniffed up into the nose and inhaled 2-3 times a day, or even every 2 hours. 15 - 20 sniffs provides an adequate dose.
    • Face mask. 2-4 drops of Lugol’s iodine 15% can be applied to a face mask, and reapplied 3 times a day.
    • Iodine oil. This can be made with 10 parts coconut oil to 1 part Lugol’s Iodine 15%, and applied around the nose and upper lip three times each day. The iodine does stain the skin yellow temporarily, but it is a good way to treat children who may not be able to manage a salt pipe or tolerate a mask.
    “After the 1918 Influenza Pandemic which killed an estimated 30 million people, governments financed research on the Pandemic’s causes. Over 25 years, influenza viruses were isolated and methods for killing them with various agents discovered. Iodine was the most effective agent for killing viruses, especially influenza viruses. Aerosol iodine was found to kill viruses in sprayed mists, and solutions of iodine were equally effective. In 1945, Burnet and Stone found that putting iodine on mice snouts prevented the mice from being infected with live influenza virus in mists. They suggested that impregnating masks with iodine would help stop viral spread. They also recommended that medical personnel have iodine-aerosol-treated rooms for examination and treatment of highly infected patients. Current methods of dealing with influenza infection are isolation, hand washing, antiviral drugs, and vaccinations. All of these methods can be improved by incorporating iodine into them. When impregnated with iodine, masks become much more effective, and hand washing is more effect when done with mild iodine solutions. Isolation techniques coupled with aerosol iodine would make them safer for patients, medical personnel, and all persons working with the public. Public health authorities could organize the distribution of iodine and at the same time educate the public in the effective use of iodine. Oral iodine might also boost body defense mechanisms in the upper oral and respiratory mucus. Conclusion: Iodine incorporated into masks, solutions, aerosols, and oral preparations could help to kill influenza viruses and fight off an H1N1 Pandemic.” [284]
    Ascorbic acid (vitamin C)
    Nebulisation (atomisation) delivers vitamin C directly to where it is needed in the case of a respiratory infection such as COVID-19, and it is known to be at least as, and possibly more, effective as a method of delivery than intravenous infusion.
    Materials: a nebuliser (or atomiser), ascorbic acid and sodium bicarbonate (which is needed because ascorbic acid on its own is too acidic for the airways).
    Method: Mix 100 grams of ascorbic acid powder with 50 grams of bicarbonate of soda in one litre of filtered/spring water. Once the mixture has stopped bubbling, a very slightly cloudy 10% solution of sodium ascorbate will be left. This contains 500 mg of vitamin C per 10 ml of liquid.
    Nebulising 10 ml of this solution (one dose) will deliver 500 mg, or 0.5 gram, of vitamin C. Start with one dose every 2 hours.
    If the nebulised vitamin C does not provide benefits, the airways can be opened up by nebulising magnesium sulphate (Epsom salts), which is also anti-inflammatory. [285] Dissolve 50 grams of Epsom salts in 500 ml of filtered/spring water and nebulise 10 ml of this 1% magnesium solution at a time. This will deliver 1 gram of magnesium, and can be done immediately before nebulising the vitamin C.
    Hypertonic saline
    A simple solution of salt in water could arguably be the simplest and most readily accessible, side-effect free, worm-friendly antiviral prophylaxis and treatment available. It is suitable for use via a nasal spray to reduce viral load in the airways and thereby minimize the severity of COVID-19 in the early stages of infection. It can also be used in a nebuliser to help treat already established or more severe cases affecting the lungs, and as a gargle to reduce viral load in the mouth. The extra salt from the hypertonic solution accumulates in the viral cells, forcing them to expend ATP in order to re-balance the electrolyte gradient, and this activity limits the amount of ATP available for viral replication. [286] And there is a simplified report of this research here.
    ❓Hydrogen peroxide (H2O2) (See Hydrogen peroxide.)
    "Viral syndromes start or are strongly supported by ongoing viral replication in the naso- and oropharynx. When appropriate agents are nebulized (into a fine spray) and this viral presence is quickly eliminated, the rest of the body "mops up" quite nicely the rest of the viral presence. The worst viral infections are continually fed and sustained by the viral growth in the pharynx. Probably the best and most accessible agent to nebulise would be 3% hydrogen peroxide (1 to 5 cc of 3% peroxide with volume brought up to 10 to 12 cc with filtered water) for 15 to 30 minutes several times daily." [287] Also see Curing Viruses with Hydrogen Peroxide.
    DMSO
    "DMSO can be readily combined with other anti-pathogen agents, such as sodium ascorbate (vitamin C) and magnesium chloride. Anecdotally, this DMSO-vitamin C-magnesium chloride combination has proven to be very effective in clearing biofilms and their underlying pathogen colonies. This can be done with 1 to 5 cc of 99.9% DMSO brought up to 10 to 12 cc (for nebulisation) with a combination solution of vitamin C and magnesium chloride. Precise concentrations are not critical, and the combination solution can be quickly and easily made by adding about 2 teaspoons of sodium ascorbate powder and 2 teaspoons of magnesium chloride powder to about a half cup of water. Since the sodium ascorbate will oxidize over several hours as it turns yellow, it can be made separately from the magnesium chloride solution, which remains very stable and does not significantly deteriorate over time." [288]
    Hyperbaric oxygen
    "...hyperbaric oxygen therapy (HBOT) would be an excellent treatment adjunct against severe COVID-19 and a superior alternative to ventilators, which have been shown to cause harm in many patients and increase the risk of death. (Link expired)
    Grapefruit seed extract (GSE) and xylitol
    Nasal sprays containing GSE and xylitol (e.g., Xlear Sinus Care) may prevent the spread of viral respiratory infections including SAR-CoV-2 and H1N1. GSE significantly reduces the viral load while xylitol prevents attachment of the virus to cell walls. [289]

    Other considerations when fighting viral infections

    Ayurvedic remedies [290]

    ❓ Aegle marmelos (also known as Bael, Bengal quince, golden apple, Japanese bitter orange, Sirphal, stone apple and wood apple) has culinary uses and is employed as an ayurvedic remedy in Indian traditional medicine to treat various illnesses, including irritable bowel syndrome and ulcerative colitis. Sandu bilagyl, a herbal tea combining Aegle marmelos and sugar, is claimed on several commercial websites to have anthelmintic effects, [291] but this characteristic is not mentioned in more detailed articles found online, [292] where Aegle marmelos is only reported to have pesticidal properties. This may have have been extrapolated by vendors to suggest a possible anthelmintic effect, but there is so far no evidence that it harms intestinal worms, and no self-treaters have reported their experience with it.

    The following ayurvedic remedies are used, in combination, to treat pinworms, so may also have an adverse effect on other helminths:

    • ⚡Triphala. This is an Ayurvedic herbal formula combining three myrobalans: Amalaki (Emblica officinalis), Bibhitaki (Terminalia bellirica/Terminalia bellerica), and Haritaki (Terminalia chebula). The latter two of these are reported to be anthelmintic, but they also have laxative properties, and it may be this characteristic, rather than actual worm killing ability, that is the source of any ‘anthelmintic’ effects.

    Chinese herbal medicines [293]

    ❌ Anthelmintic Chinese herbs

    • Bing Lang (Semen arecae). Used against roundworms and flukes.
    • Chuan Lian Gen Pi (Cortex meliae radicis). Used against roundworms.
    • Da Huang (Radix et rhizoma rhei). Used in combination remedies to treat flukes.
    • Guan Zhong (Rhizoma dryopteris crassirhizomae). Used in combination remedies to treat hookworms.
    • Ku Lian Gen Pi (Cortex meliae radicis). Used to treat pinworms, and in combination remedies to treat hookworms.
    • Lei Wan (Sclerotium omphaliae). Used specifically to treat hookworms.
    • Qian Niu Zi (Semen pharbitidis). Used in combination remedies to treat flukes.
    • Qu Hui Wan (Dispel Roundworms Pill). Used against roundworms.
    • Shi Jun Zi (Fructus quisqualis). Used against pinworms.
    • Tu Jing Jie (Herba chenopodii ambrosioidis). Used in combination remedies to treat hookworms.
    • Wu Mei Wan / Wu-Mei Wan (Mume Pill). A 10-herb classical formula used to treat intestinal parasite infections, including roundworms.
    • Zi Su Ye (Folium perillae). Used in combination remedies to treat hookworms.

    Homeopathic remedies

    ✅ Most homeopathic remedies are unlikely to have any adverse effect on human helminths. For example, the influenza remedy, Oscillococcinum, has been taken occasionally by one hookworm host without harming her colony. [294]

    ❌ Antiparasitic homeopathic remedies [295]

    • Cina (a homeopathically potentised form of Eurasian wormwood - Artemisia cina)
    • Cuprum oxidatum nigrum
    • Indigoz
    • Podophyllum
    • Sabadilla
    • Santoninum
    • Spigelia
    • Stanum
    • Teucrium marum

    Light therapy

    No reports have been received about adverse effects on human helminths of any form of light therapy (red light therapy, near-infrared, far-infrared, etc.), and one NA host has reported regularly using a red light full body bed without issue. [296]

    Phage therapy [297]

    ❓ While it is unlikely that bacteriophages will harm helminths, one hookworm host who took a short course of doses of a cocktail of several phages has reported experiencing a slight temporary reduction in worm benefits following this treatment. The product he took included preservatives (8-hydroxyquinoline sulfate-0,0001 g / ml [calculated content]; or 8-hydroxyquinoline sulfate monohydrate in terms of 8-hydroxyquinoline sulfate-0.0001 g / ml [calculated content]) which may have been responsible for this effect. [298]

    Electromagnetic stimulation

    ✅ Several forms of electromagnetic stimulation have been used by hosts of human helminths, including Transcutaneious Electrical Nerve Stimulation (TENS) and Pulsed Electromagnetic Field (PEMF) therapy, and these appear not to have had any effect on the worms. [299]

    Foods, supplements, spices, herbs and fungi

    There are lists on the internet claiming that common foods and spices such as pumpkin seeds, turmeric, and even carrots, will kill helminths, but normal dietary amounts of most unprocessed foods, spices and herbs, will not harm helminths.

    For example, carrots and sweet potatoes are both claimed to be 'antiparasitic' in some online lists, but one individual who eats 400 g (14 oz) of one or other of these vegetables every day, is still able to maintain a thriving hookworm colony, and there are others who have eaten far more than this without harming their worms.

    The only problem that is likely to arise with foods, spices or herbs is when these, and particularly herbs, are artificially concentrated or processed to create extracts or tinctures. Any herbal medicine that claims to have antiparasitic, or even antibacterial or antifungal properties may present a potential risk to human helminths and should therefore be approached with caution. The ultimate potency of these substances will depend on a number of factors, including, in the case of plants, the part used, the season it was picked, [300] the method of extraction, [301] and the extent of concentration and/or processing, as well as dosage.

    The effect of such substances also appears to vary between individuals, probably due to differences in the strength of their immune response to helminths, and some people, particularly those who have more difficulty holding on to a viable helminth colony and therefore need more frequent top-ups (especially a subset of patients with IBD or coeliac disease, and some with allergies) may find that ingesting certain substances that have no effect on the worms of other hosts may tip the balance in their case and cause a temporary dip in worm benefits, or even a loss of worms. For example, one helminth host has reported taking peppermint oil continuously without any apparent adverse effect on his worms, yet another individual could not keep a worm colony at all while taking peppermint oil.

    In the case of some foods and herbs, a single part of the plant, usually a part that is not normally eaten - perhaps the bark or root - may have antiparasitic properties, while other parts of the same plant may be perfectly safe to eat. For example, the seeds of pomegranates are safe to eat, while the bark of the stems of this plant contains an anthelmintic compound, and the bark of the root contains an even more potent form of this alkaloid, which is used to treat roundworms, pinworms and tapeworms.

    So, while bearing in mind the general principles set out in the Introduction and the last few paragraphs above, and using the details in the list below, helminth hosts need to observe their own responses and learn what they, as individuals, can and cannot safely consume while hosting helminths.

    There will often be a warning indication whenever one's worms are not happy. This may be a general loss of wellbeing, or a return of specific symptoms. For example, one person always gets a marked increase in nasal congestion if something compromises the health of his worms.

    Foods

    ✅ Food items considered safe unless marked otherwise

    • Bitter melon (Momordica charantia) Also known as Momordica chinensis, goya, karela, ampalaya, bitter apple, bitter gourd, bitter squash and balsam-pear. This cucumber-shaped vegetable is found in Asian markets, and aqueous extracts of its leaves and seeds have both been shown to have a dose-dependent adverse effect on one type of adult non-therapeutic helminth (Strongyloides) in test tube studies [302] and both fruit and seeds have been, and still are, used in a number of countries to treat pinworm infections, and for expelling parasites generally. However, the quantities of fruit and seeds that are quoted as being necessary in order to eradicate worms are rather large, for example two whole melons each day for seven to ten days, repeated after two months. It is therefore unlikely that normal dietary amounts of bitter melon fruit will adversely affect therapeutic helminths, and one hookworm self-treater has reported that bitter melon is a regular part of her diet, but has never adversely affected her worms. [303]
    • ⚡ Breast milk (human). There has been one report of a child with severe eczema who was inoculated with hookworms while still being breastfed, and who received only moderate benefits from the worms until breast feeding was suspended. Thereafter, the benefits increased markedly, suggesting that something in the breast milk was inhibiting the worms, possibly the lauric acid which is also found in coconut products. [304]
    • Carrot (Daucus carota, subsp. sativus). The taproot of the carrot is rich in beta carotene, a precursor for vitamin A, which has been claimed to increase resistance to penetration by larvae. Carrots have also been claimed to be offensive to all parasites and valuable in the elimination of threadworms, but normal dietary amounts are not harmful to therapeutic helminths, and many helminth hosts have regularly eaten significant quantities of this vegetable (e.g., up to 1kg daily [305]) without adversely affecting their worms.
    • Chicory (Cichorium intybus). This is well known for its toxicity to intestinal parasites, and studies have indicated that ingestion of chicory by farm animals results in reduced worm burdens. This plant contains volatile oils similar to those found in plants in the related genus Tanacetum, which includes ❌Tansy, and is said to be similarly effective in eliminating intestinal worms, but eating dietary quantities of chicory has not been reported to adversely affect human helminths.
    • Citron (Citrus medica). Alcoholic extracts of the rind of citron have shown ‘moderate’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies. These extracts may therefore also have an adverse effect on other helminths, though there is no evidence that eating normal dietary amounts of the flesh of this fruit might harm human helminths.

    • ⚡ Coconut. Coconut products contain medium-chain-triglycerides (MCT), some of which have been shown to be effective against many parasites including giardia, other protozoa, and also tapeworms. (Also see, Fatty acids.) The fats in coconut oil are 40% lauric acid (lipid number: C12), the MCT most well-known for its antibacterial, antimicrobial and antiviral properties, and the one most likely to be responsible for any adverse effect on helminths. Fractionated coconut oil contains primarily caprylic acid (C8) and capric acid (C10) [306] which appear not to harm helminths. One hookworm host who routinely consumes 3 to 10 tablespoons daily of MCT oil containing 55% caprylic acid and 35% capric acid has reported that this has no adverse effect on his colony, and that he is able to incubate more NA using eggs from this colony. [307]
      Coconut fiber, especially in the form of dried or ground coconut flesh (desiccated coconut, coconut flour) has long been used to expel intestinal worms, both in humans [308] and animals, [309] [310] and becomes more effective as the quantity increases. Eating an entire cake baked with coconut flour brought a return of disease symptoms for one hookworm host. [311]
      Most helminth hosts find that they can eat normal dietary amounts of coconut products without adversely affecting their worms, as can be seen in these examples. [312] [313] [314] [315] [316] [317] [318] Nevertheless, coconut products do have a potential to affect human hookworms in some individuals, especially coconut oil and coconut milk, and the effect is often dose-dependent. For example, one hookworm host who checks the egg output of his worms has reported that they twice produced zero eggs for a period of time after he drank coconut milk. Another hookworm host gets increased pain a few hours after ingesting coconut milk or powder. [319]
      Someone else found that, while consuming 200 mg of coconut milk caused a temporary return of mild symptoms of his disease, he regularly eats coconut oil without any obvious problem, but other hookworm hosts have reported a return of disease symptoms after consuming coconut oil. [320] [321] [322]
      A hookworm grower has reported that he can consume coconut products "somewhat regularly" and still be able to incubate plenty of larvae, [323] but another grower has found that, while his colony continues to thrive and produce eggs when he takes 3 tablespoons of coconut oil each day, [324] about ⅓ of any larvae produced will be dead, and the rest “less energetic”, so he normally restricts himself to 2 tablespoons per day.
      Coconut water may also adversely affect a hookworm colony, as one host found after drinking 1 litre of coconut water, [325] and another found after drinking coconut water kefir, [326] but one NA host has found that the coconut essence-flavoured sparkling water produced by La Croix had no ill effect on his worms. [327]
      One hookworm host finds that all coconut products have an adverse effect, [328] while two others have said that even small amounts of coconut quickly result in a loss of benefits. [329] [330]
      Some CBD oils for vaping are suspended in coconut oil. However, most of these are only a 3% suspension, so *may* be safe for use while hosting human helminths.
      Coconut sugar should not carry the same degree of risk because, whereas coconut milk, oil and flour are all obtained from the flesh of mature coconuts, and coconut water is also from inside the fleshy part of the coconut, coconut sugar comes from the sap of coconut palm flower buds and consists largely of sugars.
      The seasoning sauce, Coconut Aminos, is also made from coconut tree sap, and at least one hookworm host has used this regularly without issue. [331]
    • Cranberry (Vaccinium macrocarpon). This is claimed by some sources to contain antiparasitic enzymes, and cranberry powder is sometimes included in proprietary antiparasitic formulations, although evidence for its effectiveness in this context is lacking, and there have never been any reports of any form of cranberry having an adverse effect on therapeutic helminths. Cranberry juice was used traditionally to treat urinary tract infections (UTIs), but it works by changing the bacteria in ways that prevent bacterial adhesion rather than killing them. While drinking 15 fl oz of cranberry juice per day is claimed to help arrest a mild urinary infection, cranberry powder capsules are more effective and D-mannose, a cranberry derivative, is even more effective than the powder.
    • Dietary fibre (fiber). Some sources claim that eating a lot of fibre may reduce the number of intestinal worms, but fibre consumed as an integral part of a normal diet has not been reported to be a problem for human helminths.

    • ⚡Fatty acids. Research on the direct effect of fatty acids on helminths is limited. However, the poly-unsaturated fatty acid (PUFA), linoleic acid, has shown in vitro nematocidal activity against both C. elegans [332] [333] and H. contortus, [334] and it has been proposed that unsaturated fatty acids are likely to play a role in the natural attrition of S. mansoni and S. haematobium lung-stage larvae. [335] It has been hypothesised elsewhere that exposure to some fatty acids could cause lethal damage to helminths by interacting with, and compromising, the integrity of the organisms's cuticle, [336] and in vitro exposure to arachidonic acid has been shown to cause disintegration of the surface membranes of the trematode, Schistosoma spp., eventually leading to parasite death. [337] It is likely that the undoubted adverse effect of some coconut products on NA - and possibly also TTO - in some hosts is due to the fatty acids these products contain, especially lauric acid (C12), and the evidence from the studies presented here suggests that other fatty acids may have an adverse effect on therapeutic helminths in a similar dose-dependent manner, influenced also by the strength of the host's immune response to helminths. People who are hosting NA, in particular, who are not experiencing the benefits they expected should therefore consider the possible effect of any fatty acids they consume, and experiment accordingly. (Also see medium-chain triglycerides and ⚡coconut.)
    • Guayusa tea (ilex guayusa). The leaves of this Amazonian holly tree are brewed to make a caffeinated drink. One hookworm host who regularly drinks this tea has not noticed any adverse effect on her worms. [338]
    • ❓ Genetically modified foods (GMOs). Some food crops, such as corn and rice, have been genetically modified to produce ❌Cry5B, a protein that can kill intestinal worms, including the human hookworm. Bacillus thuringiensis (Bt), the bacterium that produces Cry5B, is also applied as a natural insecticide on crops on some organic farms, but there is no indication yet that GM foods are a potential threat to human helminths.
    • Grapefruit (citrus paradisi). The flesh of the common grapefruit is perfectly safe to eat while hosting helminths, although ⚡grapefruit seed extract does have a potential to harm helminths due to the typical addition of synthetic adulterants. Also potentially harmful are some extracts of the rind of ❌Citrus decumana, a close relative of the grapefruit.
    • Hibiscus. One hookworm host has drunk many litres of strong, homemade hibiscus tea over the years without ever harming her colony. [339]

    • ⚡ Honey. Honey can contain antivirals [340] and powerful antimicrobials [341], some of which can have effects comparable with those of antibiotics such as clarithromycin, and certain types of honey have particularly potent antimicrobial activity. Several people have suspected that Manuka honey (which inhibits dental plaque as effectively as chlorhexidine mouthwash [342]) has adversely affected their worms, while a few others have reported that raw honey reduces the benefits from their worms, [343] in one case causing increased pain several hours after ingestion, [344] and someone else, who had a few teaspoons of raw honey on two occasions, 4 days apart, has reported that some of his symptoms made a limited return for a day after each ingestion. [345] Research reported in 2014 may explain why raw honey might have this effect. [346] However, one hookworm host, who regularly takes a manuka honey/apple cider vinegar combination, has not noticed any loss of benefits, and another two have reported no apparent adverse effect on their worms after consuming raw honey. [347] One of these individuals reports having eaten quite large amounts of raw honey continuously during his first 3 years with NA and never noticed anything untoward. [348] Regular honey appears to be generally worm-safe, [349] and, demonstrating the experience of many others, one hookworm host has said that she can consume 2-4 teaspoons of regular honey daily without any issues, but that manuka and any honey labeled as "raw" causes problems. (Note about the different types of honey: Manuka honey (very viscous with a dark cream to dark brown colour) is produced by bees foraging specifically on the mānuka tree; Wild honey is often sourced from free-range hives, rather than box hives, by native gatherers who only remove larger honeycomb impurities; Raw honey is typically only strained to remove physical impurities such as beeswax and dead bees. Regular, commercial honey usually goes through additional processing including finer filtration to remove all debris and air bubbles, and pasteurisation to destroy yeasts. Regular honey may also be subject to utrafiltration, which further refines the product to make it more transparent and smooth, but also removes beneficial nutrients like pollen, enzymes and antioxidants.)
    • ❓ Indian gooseberry. (Phyllanthus emblica, also known as Emblica officinalis, emblic, emblic myrobalan, myrobalan, Malacca tree and amla.) While there are websites online that claim anti-parasitic effects for P. emblica, and one study found that P. emblica exerted toxic effects on a parasitic flat worm, [350] there is no compelling evidence in the scientific literature for a possible adverse effect on hookworms. Neither have any reports of an adverse effect on their worms been posted by any NA self-treaters, and one study found that a traditional Thai preparation containing P. emblica actually extended the life of the research worm, C. elegans. [351]
    • Kombucha (Medusomyces gisevii, also called tea mushroom, tea fungus or Manchurian mushroom.) This fermented drink does not harm helminths. [352]
    • Lime (Citrus acida). While alcoholic extracts of the rind of limes have shown ‘moderate’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies [353], and extracts of the rind may have an adverse effect on other helminths, there is no reason to believe that eating the flesh of limes will harm human helminths.

    • Medium-chain triglycerides (MCTs) are extracted from ⚡coconut oil, amongst other things, and can be divided into four groups: 1. caproic acid (C6), 2. caprylic acid (C8), 3. capric acid (C10) and 4. lauric acid (C12). [354] Of these, lauric acid is the most well-known for its antibacterial, antimicrobial and antiviral properties, which may explain why coconut oil (which is 40-50% lauric acid) appears more likely to affect human helminths than products containing a mixture of all four types of MCT, such as the milk of cows, sheep and goats, the fatty acids in which contain 10-20% mixed MCTs. (Also see ⚡fatty acids and ⚡coconut.)
    • Onion (Allium cepa). This is used as an ingredient in some proprietary deworming formulations and has been claimed to create an 'uninhabitable environment' for intestinal worms and to help eradicate tapeworms in particular. However, if eaten in normal dietary quantities, onion should not harm therapeutic human helminths.
    • Organic foods. While these are less likely to be contaminated with chemicals, some organic farmers apply Bacillus thuringiensis (Bt) to their crops as a natural insecticide. This bacterium produces ❌Cry5B, a protein that can kill intestinal worms, including human hookworms. However many hosts of human helminths have eaten organic foods without them affecting their worms.

    • Papaya (Carica papaya, also known as or papaw, pawpaw or paw paw). The fruit and leaves contain both antiseptic and antiparasitic compounds, including one called carpaine, which is claimed to kill and expel intestinal worms. Papaya latex has been shown to be an effective anthelmintic against a variety of nematode parasites. However, it is unlikely that eating normal dietary amounts of the flesh of the fruit will adversely affect human helminths and, when someone who grows his own hookworms added a large amount of papaya - comparable to a human eating 2 or 3 pawpaws - to a petri dish full of larvae, these were unaffected. However, ⚡Papaya seeds are also rich in caricin which is reportedly effective in expelling roundworms. A randomized, placebo-controlled study found that a 20 ml dose of a mixture of air-dried papaya seeds and "natural" honey was effective against various types of human intestinal parasite, although the honey may have contributed to this effect. The mixture demonstrated 100% efficacy in clearing TT, and 80% efficacy against NA. [355] Also see this paper.
    • Pomegranate (Punica granatum). ✅The flesh and seeds of the pomegranate fruit have not been reported to harm human helminths. However, ❌pomegranate extracts should be avoided because the bark and stems of this plant contain an anthelmintic compound, punicine, and the bark of the root contains an even more potent form of this alkaloid. [356] Extracts of the bark of both the root and stems, and extracts of the rind/peel of the fruit, have a strong anthelmintic effect and are used as traditional remedies to treat roundworms, pinworms and tapeworms, to which they are said to be highly toxic. Alcoholic extracts of the rind/peel have also shown ‘moderate’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies. [357] These extracts may therefore have an adverse effect on other helminths, and one hookworm host has reported losing benefits from her colony after accidentally consuming a small amount of pomegranate extract. [358] Pomegranate peel is used in small quantities in dietary supplements and food preservatives and may not be a significant threat to human helminths in this form. However, ❌pomegranate peel powder, which is available for purchase as a remedy for certain health conditions, might be harmful to helminths if it is used in quantity, for example as an ingredient in smoothies. One hookworm host found that while one company’s pomegranate fruit powder is produced from only the dried pomegranate arils (the seeds and their red fleshy coatings), and not including any peel, the same company’s pomegranate juice powder is produced from the whole fruit - both the seeds/arils and the peel. Neither product carries details on their packaging of which part of the pomegranate they contain, and this self-treater had only realised there was a difference when taking the latter product caused a return of his disease symptoms. The Pom Wonderful product is reportedly made from the arils, so should be safe for use by hosts of human helminths.

    • ✅ Pumpkin and ⚡ Pumpkin seeds (Cucurbita species). This is also referred to as squash or gourd, depending on species, variety and local parlance. Eating the flesh of the pumpkin/squash/gourd is unlikely to have any adverse effect on any human helminth. ⚡Pumpkin seeds contain an antiparasitic compound called curcurbitacin and they were used traditionally as a remedy for tapeworms and roundworms. However, their effect is likely to be dose-dependent, and large amounts are recommend by herbalists for deworming, e,g., up to 25 ounces for adults. Some hookworm hosts have reported no adverse effect on their colony after eating pumpkin seeds, [359] [360] while others have experienced either a temporary return of disease symptoms or even a loss of their colony. For example one found that eating a daily salad for a week with a mixed seed/nut topping containing pumpkin seeds killed her entire colony. [361] Another NA host has reported that taking 1000 mg of ⚡pumpkin seed oil daily for 2 months significantly reduced the fecundity of his NA, resulting in incubations producing only a handful of L3 larvae after having previously always yielded hundreds of larvae per incubation over a 7 year period. [362] Since this individual is not treating a disease, but only acting as a reservoir donor, it is not known whether this amount of pumpkin seed oil might affect disease remission.
    • Radish (Raphanus sativus). This has been used as an alternative treatment for intestinal parasites, and is included as an ingredient in some proprietary deworming formulations, but it is unlikely to have any adverse effect on human helminths if eaten as part of a normal diet.

    • ❌ Sauerkraut Sauerkraut will not kill human helminths, but it can cause significant digestive upset in some people, sufficient to cause a setback in the course of their treatment, and including diarrhoea severe enough to flush hookworms from the gut. Two hookworm hosts have reported experiencing significant upset stomach, “gut issues” and diarrhoea after eating only 2 and 3 forkfuls of sauerkraut respectively [363][364] and another NA host lost his entire colony due to extreme diarrhoea following his first encounter with sauerkraut. [365]
    • ❓Seaweed (macroalgae). Five poly-unsaturated fatty acids (PUFAs) identified in two Nordic seaweeds (S. latissima and L. digitata) were found to have in vitro effects against helminths in swine (Ascaris suum) and sheep (Teladorsagia circumcincta), with a clear synergistic effect being apparent when selected compounds were tested in combination. “Collectively, our data reveal that fatty acids may have a previously unappreciated role as natural anti-parasitic compounds, which suggests that seaweed products may represent a viable option for control of intestinal helminth infections.” [366] However, there have been no reports so far of NA or TTO being adversely affected by the consumption of seaweed products. (Also see, ⚡fatty acids.)
    • Sweet potato (Ipomoea batatas). Like the carrot, this root vegetable is rich in beta carotene, a precursor for vitamin A, which it has been claimed can increase resistance to penetration by larvae. However, numerous hosts of human helminths regularly eat significant amounts of sweet potato (e.g., up to 1kg daily [367]) without any adverse effect on their worms.
    • Tea. The aromatic beverage prepared by pouring hot or boiling water over cured or fresh leaves of the Camellia sinensis plant, e.g., green tea, black tea, white tea and oolong tea, is generally harmless to therapeutic helminths. However, there may be a risk of harm to human helminths if ❓medicinal quantities of concentrates, extracts or tinctures made from green tea are consumed. [368]
    • ⚡ Thai curry. One hookworm host found that a strong green Thai curry upset his colony to the extent that he needed to add a top-up dose to recover the benefits he had enjoyed previously. [369]
    • Walnut, English (Juglans regia). Also known as the Persian, common, California, or Carpathian walnut. This does not appear to have gained a reputation as an anthelmintic, unlike the ⚡black walnut.
    • Watermelon flesh is not a problem for either NA or TTO, but there has been one report from an NA host that eating a "bunch" of ⚡watermelon seeds at a barbecue caused a loss of all worm benefits after about three days. [370]
    • Xylitol. One hookworm host has reported [371] that he takes xylitol daily in place of sugar and has not noticed any effect on his colony.
    • Yam (Dioscorea). Like carrot and sweet potato, the yam is rich in beta carotene, a precursor for vitamin A which is thought to increase resistance to penetration by larvae. However, numerous hosts of human helminths regularly eat this vegetable without adversely affecting their worms.

    Nutritional supplements

    ✅ Supplements safe for human helminths, unless marked otherwise

    • 5-HTP (5-Hydroxytryptophan, also known as oxitriptan and marketed under trade names such as Cincofarm, Levothym, Levotonine, Oxyfan, Telesol, Tript-OH and Triptum) This is used as an antidepressant, appetite suppressant and sleep aid. One hookworm host has reported [372] taking 5-HTP without any adverse effect on her worms.
    • Acetylcarnitine (Acetyl-L-carnitine, ALCAR or ALC) is produced naturally by the body, and has been taken by at least two hookworm hosts without issue. [373] [374]
    • Acetylcysteine (also known as N-acetylcysteine, N-acetyl-L-cysteine and NAC). Three hookworm hosts have reported taking this without causing any problems for their colonies. [375] [376] [377]
    • Activated charcoal (also known as activated carbon). There has been one confirmation that charcoal doesn’t harm hookworms [378], and another report that taking it didn't cause any return of symptoms in a Crohn’s patient. [379]
    • Alpha lipoic acid (ALA), also known as Lipoic acid (LA), α-lipoic acid and thioctic acid. This organosulphur compound is made naturally in animals, where it is essential for aerobic metabolism. Because of its antioxidant properties, it is also sold as a dietary supplement and is available in some countries as a pharmaceutical drug. One host of both hookworms and human whipworms has taken between 300 and 600 mg of alpha lipoic acid per day without any harm befalling their worms.
    • Amine oxidase (also known as diamine oxidase, DAO and histaminase). This enzyme, which is involved in the metabolism of histamine, is produced by the body and found in high concentrations in the digestive tract and placenta. It has therefore been suggested [380] that it is unlikely to be harmful to helminths, although there are not yet any reports to confirm this.
    • ASEA Redox Supplement. This “catalytically processed” saline solution should not harm helminths, a fact confirmed by one hookworm host. [381]
    • ❌ Atrantil contains three active botanicals: M. balsamea Willd (peppermint) leaf extract, quebracho extract and conker tree extract. While ⚡peppermint oil has proved to be a problem for some hosts of human helminths (see peppermint reference), it is possible that the leaf extract may be worm-safe. However, quebracho extract has been shown to effectively reduce worm burdens in sheep. [382]
    • Bee pollen. One hookworm host has reported that eating small amounts of this has had no obvious adverse effect on this worms.
    • ❌ beta-Sitosterol has demonstrated anthelmintic effects [383] and two hookworm hosts have reported a return of their disease symptoms after taking beta-Sitosterol. [384], [385]
    • Boron and Borax. Boron is a chemical element and a trace element in human and plant nutrition. Only small amounts of boron are required for health and an excess can be toxic. It is unlikely to have an adverse effect on helminths when consumed in dietary quantities. Borax is a mineral containing boron which has antifungal properties and also certain health risks. One hookworm host has reported taking 1/2 teaspoon borax per day for 6-7 weeks without harming his colony. [389] [390]
    • ❓Bpc 157 This pentadecapeptide, also known as PL 14736, was taken intranasally over 4 days by one NA host who has reported no negative effect on his colony in that time. [391]
    • Chlorella. One hookworm host took ½ teaspoon of this single-cell green algae daily for a year without any obvious effect on her worms. [392]

    • ❓ Chlorophyllin. This semi-synthetic derivative of chlorophyll is used as a food colouring agent (e.g., E number E141) and as a treatment aimed at reducing various bodily odours, but its suitability for use by helminth hosts has been questioned because of its apparent ability to kill mosquito larvae and other small animals at low concentrations, although this effect appears to be dependent on the presence of sunlight. (Also see Chlorophyll.)
    • Chondroitin Sulfate. In an animal study, chondroitin sulfate was shown to prevent threadworms from establishing in the digestive system, but one NA host has taken 900 mg daily for several years without any adverse effect on his worms.
    • Colostrum. A hookworm host has taken this without any adverse effect on her colony. [393]
    • ❓ D-mannose. This naturally occurring simple sugar is the ingredient in cranberries that makes their juice effective against urinary tract infections. Pure D-mannose is 10-50 times stronger than cranberry juice, making it more suitable for stubborn cases of UTI, and it reportedly resolves more than 90% of all UTIs within 1-2 days. [394], [395]
      Taking steps to make the urine less acidic (e.g., by taking Tums[396]) might make cranberry-based treatments even more effective. D-mannose is non-toxic, produces no adverse effects and, while there have been no reports to confirm it’s lack of adverse effects on human helminths, it is unlikely to do them any harm.

    • ⚡ Digestive enzymes, such as papain and bromelain, are said to make the intestinal tract inhospitable to parasites by dissolving their outer layers. In particular, papain - the milky juice of the unripe papaya - is claimed to be a powerful agent for destroying roundworms. One subject has reported a return of symptoms after taking a product containing papain, bromelain, protease, lipase and amylase for several weeks, and another individual has reported losing their entire hookworm colony after taking Healthy Origins Broad Spectrum Digestive Enzymes [397] (amylase, protease, peptidase, alpha-galactosidase, glucoamylase, acid maltase, cellulase, pectinase, protease, lipase, lactase, beta-glucanase, invertase and hemicellulase).
      However, several other hookworm hosts have taken digestive enzymes, including Terranova's Quercetin Nettle Complex which contains bromelain, without any obvious effect on their worms, [398] and one of these has regularly taken pancreatin-based products from different manufacturers, mostly from Pure Encapsulations, but also a lipase product by Integrative Therapeutics. Another hookworm host who regularly takes digestive enzymes but has never noticed any adverse effect on his colony, generally avoids papain and bromelain, but regularly takes pancreatin, lipase, Acid Ease, and occasionally Udo's Choice enzymes. Udo's Choice brand does contain some bromelain, but only a small amount. [399] Someone else noticed no adverse effect on his NA colony after taking Enzymedica Digest Spectrum Multiple Food Intolerance Formula (amylase, xylanase, protease, alpha galactosidase, glucoamylase, lactase, lipase, maltase, cellulase, invertase, pectinase and hemicellulase). [400]
      And two other NA hosts have taken a product containing lipase (40,000 USP units), protease (126,000 USP units) and amylase (168,000 USP units) without issue. [401]See also ✅Papaya, and, for a brief explanation of how to stimulate one’s own natural enzyme production using a simple form of micro-massage, see this article.
    • Diindolylmethane (DIM). 3,3′-Diindolylmethane has never been mentioned by hosts of human helminths as being harmful to their worm colonies, which is unsurprising because it’s a natural compound that is created in the body from the digestion of cruciferous vegetables such as cauliflower, broccoli and Brussels sprouts. Supplements containing DIM are simply a concentrated form of this natural substance.
    • Folic Acid has been claimed to help prevent the proliferation of intestinal parasites at a dosage of 400 - 800 mcg (0.4 - 0.8 mg) per day. However, this is not a problem for human helminths because they do not proliferate within their hosts, and there have been no reports of adverse effects from hosts of human worms. One subject has taken a daily vitamin B-complex supplement containing 400 mcg of folic acid without any apparent effect on his hookworms, and another has taken 800 mcg of folate (as calcium L-5 methyltetrahydrofolate) every day for over 4 years with no adverse effect on his hookworms.
    • FOS (fructooligosaccharide) is said to inhibit parasites from attaching to the intestines but no helminth host has reported any problem with this so far.
    • Ginseng. Members of the genus, Panax, appear not to be harmful to human helminths, and one hookworm host has reported taking ginseng without noticing any untoward effect. [404]
    • Glucosamine may be beneficial for roundworms. Applying this amino sugar experimentally to one roundworm species caused the treated worms to live around 5% longer than their untreated counterparts. [405]
    • Glutathione. One hookworm host who has taken liposomal glutathione says he’s confident that this did not harm his worms, [406] and several people who have taken other oral glutathione supplements have reported no adverse effects. A hookworm host who received intravenous injections containing glutathione experienced no adverse effect on her NA colony. [407]

    • Grape seed extract. After taking 4 capsules of a product containing 200mg grape extract, 200mg grape seed extract and 200mg Muscadine grape every day for 2 weeks, one hookworm host carried out a successful incubation, indicating that the product had not adversely affected her colony. [408] (Also see Grapefruit seed extract (GSE), which can adversely affect human helminths in some people.)
    • Iron. Supplementary iron taken orally does not harm helminths, but one hookworm host has reported having apparently lost her worms on two occasions after receiving ❓ intravenous iron infusions. [409]
    • ❓ Lumbricus Tonic. This discontinued Nutricology product contained a powdered earthworm extract as well as ⚡sweet flag root extract. The herb was last on the list of ingredients however, and there had been no reports by hosts of therapeutic helminths to suggest that the product might be a problem for worms.
    • Melatonin. This hormone, which is commonly used as a sleep aid, has been taken by many helminth hosts, none of whom have reported any adverse effects on their worm colonies.
    • Modified citrus pectin (also known as citrus pectin, Pecta-Sol and MCP) is a complex carbohydrate extracted from citrus fruits using a chemical extraction process that makes it soluble, absorbable and more digestible. This is unlikely to have any effect on helminths.
    • Moringa (Moringa oleifera, also known as drumstick tree, horseradish tree, ben oil tree and benzoil tree) Although described as a “natural anthelmintic”, moringa has been taken by two helminth self-treaters with no apparent adverse effect on their hookworms. The first takes a 500 mg capsule of 10 to 1 extract (from 5000 mg of Moringa olifeira) twice a week, [410] while the second grows and harvests her own moringa. [411] Whatever anthelmintic properties moringa might have may depend on the part of the plant used.
    • ❓ MSM (Methylsulfonylmethane) is claimed by one source to be effective against many types of intestinal worm including Enterobius (pinworm [US], threadworm [UK]) and the roundworm, Ascaris. It is suggested that MSM blocks the interface between the parasite and the host by competing with the parasite for binding sites at the surface of the mucous membrane, and that the parasites may find the resulting MSM 'film' impenetrable. However, it may be necessary to take 10,000 mg of MSM per day for three or four weeks to achieve this effect, and one helminth host has reported that he has occasionally taken up to 1 heaped tablespoon of MSM while hosting helminths to treat eczema flare-ups, and has not noticed any loss of worm benefits. Someone else who takes a heaped teaspoonful of equine MSM every other day has also reported observing no adverse effects on her NA. [412]
    • Omega-3 fatty acid supplements are taken regularly by a large number of people, and have not been reported to be harmful to any helminth species. Indeed, omega-3 fatty acids have been found to extend the lifespan of some worms. [413]
    • ❓ Oryzin (Aspergillus alkaline proteinase, aspergillopeptidase B, API 21, aspergillopepsin B, aspergillopepsin F, Aspergillus candidus alkaline proteinase, Aspergillus flavus alkaline proteinase, Aspergillus melleus semi-alkaline proteinase, Aspergillus oryzae alkaline proteinase, Aspergillus parasiticus alkaline proteinase, Aspergillus serine proteinase, Aspergillus sydowi alkaline proteinase, Aspergillus soya alkaline proteinase, Aspergillus melleus alkaline proteinase, Aspergillus sulphureus alkaline proteinase, prozyme, P 5380, kyorinase, seaprose S, semialkaline protease, sumizyme MP, prozyme 10, onoprose, onoprose SA, protease P, promelase.) There have been no reports as yet about the possible effects on human helminths of taking this mould/mold-derived proteinase.
    • Palmitoylethanolamide (PEA) This is unlikely to harm NA, and one NA host who took it for a number of weeks has confirmed that it didn’t harm his worms. [414]
    • Probiotics. It is known that a number of probiotics - predominantly Lactobacillus species - can have strain-specific effects on certain “parasites”, and, while most of these are not helminths, [415] there is some evidence that the milk-based probiotics, lactobacilli and bifidobacteria, may reduce the benefits of HDC. [416] It is also known that some bacteria are capable of mobilizing nematode-trapping fungi, [417] and that Saccharomyces boulardii can have an adverse effect on the dog roundworm, Toxocara canis, [418] but S. boulardii and soil-based organisms are likely to be OK for HDC, and S. boulardii has been taken by at least two hookworm hosts without any obvious effect on their worms. There are also many hosts of the human helminths, NA and TTO, who take probiotics regularly, in some cases several different ones each day, [419] yet there have been no reports by any of them that their worms have been adversely affected.
    • ❓ Propolis. An apitherapist speaking at the 2010 International BTeR Foundation Conference on Biotherapy had spoken about the antiparasitic properties of this bee product, and suggested that it might harm helminths. Then, a paper published in 2020 revealed that Brazilian red propolis exhibits antiparasitic properties both in vitro and in vivo, and reduces worm burdens and egg production in a mouse model of infection by the helminth, Schistosoma mansoni. [420] While this new research does not prove that propolis will be harmful to therapeutic helminths, it does make this possibility look more likely. However, one NA host has reported consuming propolis in the form of a dark brown chewing gum, without any obvious effect on his colony. He also reports that the content of propolis varies widely depending on the plants growing around the hive. [421] This variation in constituents also results in propolis from different locations having different colours, and it's possible that the different colours might have differing effects on helminths, with green propolis possibly being the safest. [422]
    • Psyllium appears not to harm hookworms, and one NA host has reported taking 4 rounded tsp of Metamucil (containing powdered psyllium seed husks) every day without harming his colony. [423]. However, psyllium is said to be effective in helping to remove parasite eggs from, and preventing parasites "taking root" in, the gut [424] and there are indications from one TT host that his regular use of psyllium may be reducing his TT colony and preventing him from culturing this species.
    • Quercetin. Taken on its own, this will not harm helminths [427] [428] but, if combined with a digestive enzyme - as it often is, to improve absorption - helminths may be adversely affected. See entry for ⚡Digestive enzymes.
    • Restore. This supplement, the active ingredient in which is Terrahydrite, was used by someone reporting that her colony is normally particularly sensitive, but was unaffected when she took Restore for long periods. [429]
    • Resveratrol. This may have an adverse effect on some helminths, [430] but this is likely to depend on dose size, and three hosts of human helminths who regularly take this compound report no adverse effect on their worms. One has taken “Perfect Resgrape Max” (400 mg trans-resveratrol) daily for many months with no apparent ill effects on her NA. [431] (People with MS might want to avoid resveratrol anyway. [432])
    • S-Adenosyl methionine (SAM, also known as SAMe, SAM-e or AdoMet) has only been reported on by one hookworm host, who observed no adverse effect on his worms after taking 200-400mg SamE per day for several months.
    • Serrapeptase (also known as serratiopeptidase, Serratia E-15 protease, serralysin, serratiapeptase, serratia peptidase, serratio peptidase, or serrapeptidase). This proteolytic enzyme (protease) has been taken occasionally by one TTO host two or three times per day over a 4 year period to treat intestinal spasm, without affecting her worms. [433] [434] It has also been taken (at 160k SPU [80mg] per day) for prolonged periods by a hookworm host with no apparent adverse effect on his colony. [435] [436]
    • Spirulina. This cyanobacterium is an effective anti-inflammatory that is being used by a number of hosts of human helminths without causing any harm to their worms. One hookworm host takes 10 grams of spirulina every day without noticing any deleterious effects on his colony. [437] However, it is worth noting that a significant proportion of algae-derived products tested in one study were found to contain an unhealthy amount of cyanotoxins caused by overgrowth of cyanobacteria due to the dumping of agricultural fertilisers into waterways. These bacterial products might not harm helminths, but they can contribute to neurological disorders like ALS in humans. [438]
    • Sulforaphane / sulphoraphane This organosulfur compound, which is obtained from cruciferous vegetables such as broccoli, Brussels sprouts and cabbages, has been taken in large amounts by one hookworm host without it affecting his colony. [439] [440]
    • Taurine is an organic acid that occurs naturally in food, especially seafood and meat (in which form it is no threat to helminths) but it is also produced synthetically and included in a number of products such as health drinks. In this form, it has been linked to a number of health problems, and has consequently been banned in some countries. It has also been shown to have anthelmintic effects, but only against a non-therapeutic helminth in mice. One helminth self-treater has taken 3 grams of taurine per day without any adverse effect on her hookworms. [441]
    • Zinc is said to inhibit the proliferation of intestinal parasites by stimulating various aspects of the immune system in the digestive tract that counteract parasites. In one animal study [442] the rodent nematode worm, H. polygyrus, was found to be better able to survive in mice which had been deliberately made deficient in zinc. Those who claim that zinc is an effective antiparasitic in humans suggest a dosage of 15-50 mg per day, but several helminth hosts have taken supplements containing this amount of zinc, in some cases continuously, without issue. One hookworm host takes 10 mg on alternate days, [443],[444] another has taken 15 mg zinc gluconate or zinc picolinate daily for several years, while yet another has taken 23 mg zinc gluconate/citrate plus 18.75 mg zinc acetate daily, and previously took 30mg zinc picolinate daily[445], all without any apparent adverse effect on their worms. However, someone who was trying to grow his own hookworms had no success with incubation while he was taking a zinc supplement, the dose of which he had increased slowly to a maximum of 130 mg/day. Three weeks after he stopped all zinc intake, he found NA larvae in his incubations for the first time. [446] ❌Zinc oxide nanoparticles (ZnO NPs) have shown strong anthelmintic effects, in vitro, against several gastrointestinal nematodes encountered in veterinary medicine. [447] [448] [449] As well as their topical use in sunscreens and cosmetics, zinc oxide nanoparticles are also used in some food products (in spite of the fact that they can cause DNA damage), but the amounts used in this application may be too small to harm human helminths.
    • Vitamin A. Supplementation with this vitamin has no adverse effect on helminths [450] but a vitamin A deficiency may reduce colonisation by worms. [451]
    • Vitamin C. This does not harm helminths, even in high doses.

    Spices and culinary herbs

    • ❓ Annatto / roucou (Bixa orellana). One in vitro study found that higher concentrations of extracts of B. orellana seeds were effective against the earthworm species, Eisenia fetida, [453] but it was not tested in intestinal helminths. There has been a single claim [454] by an NA host of a return of disease symptoms shortly after starting to take an annatto and rice dietary supplement containing a high concentration of delta-tocotrienol, a form of vitamin E: DeltaTop delta-Tocotrienol.
    • ❓ Asafoetida has been used as an anthelmintic in traditional medicine in several parts of the world [455] but there has only been one report to date of its use by someone hosting therapeutic helminths, and this user says that he hasn’t noticed any ill effect on his hookworms after occasionally consuming foods that list asafoetida as an ingredient.

    • ⚡ Black pepper (Piper nigrum). This is often used as an ingredient in proprietary parasite cleanses due to its established antiparasitic effects. It could therefore have an adverse effect on human helminths, though this is likely to be dependent on the dosage and on the form taken. So, while use of the whole spice in small quantities as a condiment is unlikely to present a problem, taking medicinal quantities of black pepper may harm helminths.
    • ✅ Bunium bulbocastanum This vegetable/spice, which is commonly called black cumin, great pignut, black zira or earthnut, is thought to be harmless to helminths when consumed in dietary quantities.

    • ⚡ Cayenne (Cayenne pepper is a type of Capsicum annuum, and cayenne powder is generally made from bird's eye chili peppers, which are classified as Capsicum minimum and often mistaken for the similar-looking Capsicum frutescens, cultivar siling labuyo, the fruits of which are generally smaller and grow in an upwards direction.) Cayenne is claimed to irritate parasites, and often appears as an ingredient in proprietary parasite cleansing products for pets and humans. There have been a couple of reports of an adverse effect on hookworms, including from someone who says that even a smidgen of cayenne causes her to temporarily lose the benefits from her worms. [456] Someone else who has reported a loss of benefits after taking a "lot" of cayenne, has said that their benefits also returned after they stopping taking the cayenne. [457] [458] Another cayenne user who reported that, in her early days with NA, she topped some meals with about ⅛ tsp of cayenne, has said that, in her case, the worms seemed to be unaffected. [459]
    • ✅ Chili pepper (chile, chile pepper, chilli pepper, or chilli). While this is used worldwide as a treatment of certain parasites, and has been demonstrated effective against fascioliasis in animals, evidence that chili might be a problem for therapeutic helminths is lacking. One hookworm host has reported that, while cayenne has had negative responses for him, chilli peppers have not been a problem in his experience, [460] and nor have jalapenos, whether fresh or pickled. [461] Another hookworm host has been reported [462] to have eaten a HUGE amount of chili during 4 years as a worm host, without any obvious adverse effect on his colony.
    • ⚡ Cinnamon is antimicrobial, as well as being claimed to be effective against parasites, including some parasitic worms, and it appears in lists of ingredients in proprietary parasite cleansing products. The main antimicrobial component of cinnamon is ⚡cinnamaldehyde, and this is most concentrated in cinnamon essential oil and cinnamon oleoresins (solid resin extracts produced using solvents) which can be very high in cinnamaldehyde. Forms containing somewhat less cinnamaldehyde are raw cinnamon and cinnamon tinctures which are dissolved in alcohol and about half the strength of raw cinnamon. As cinnamaldehyde is steam-volatile and not water soluble, aqueous extracts of cinnamon should contain less of this substance, and dehydrated/powdered extracts (the form most likely to be encountered in dietary supplements) may contain little, if any at all, so should be less of a threat to helminths. [463] Generally, the stronger the taste, the more cinnamaldehyde is likely to be present. While the raw spice is generally safe for use in cooking, there has been one report of someone with helminths relapsing after taking an unspecified supplement containing cinnamon, (link expired) and another report of a return of symptoms after eating a rice pudding made with cinnamon. [464]
    • ⚡ Clove (Syzygium aromaticum/Eugenia caryophyllus). Clove oil, which was used traditionally to kill intestinal worms and is claimed to anesthetize fish, contains several powerful antimicrobial agents. While one of these, eugenol, is claimed to be anthelmintic, its use didn't produce any loss of benefit in one helminth host who applied it liberally to a dry socket following a difficult tooth extraction, and this was in spite of swallowing and breathing eugenol and a related compound called guaiacol.
    • ✅ Cumin (Cuminum cyminum) also known as Roman caraway. While the essential oil derived from this spice has shown efficacy against Anisakis, a nematode that parasitises fish and marine mammals, [465] dietary use of the spice is thought to be harmless to human helminths. But see also, ❌ Bitter cumin, ❌ Black cumin and Bunium bulbocastanum (sometimes also called black cumin).
    • ❓Elwendia persica (aka Bunium persicum, a close relative of Bunium bulbocastanum). The possible effect of this plant on helminths is as yet unknown.
    • ✅ Fennel (Foeniculum vulgare). Fennel seed has a long history of use against pinworms and other parasites, with some authorities suggesting that the herb digests parasite eggs and intoxicates parasites. The leaves and oil are both used as dewormers, but one subject has reported no adverse effect from repeated consumption of dietary amounts of fennel seeds (link expired) and another has reported no loss of worm benefits after consuming significant quantities of fennel.
    • ⚡ Fenugreek (Trigonella foenum-graecum). Both the leaves and seeds of fenugreek have been reported to have anthelmintic properties. Alcoholic extracts of the seeds have shown a dose-dependent inhibition of motility (paralysis) in earthworms, [466] and an aqueous extract of fenugreek leaves has also shown noteworthy anthelmintic activity against earthworms. [467] After taking half a teaspoon of powdered fenugreek seeds every day for a week, one hookworm host found that his allergies returned with a vengeance. [468] However, another hookworm host ate about 150 grams of fenugreek leaves in a 2 week period without affecting his worms. [469]
    • ✅ Garam Masala The constituents of this blend of ground spices vary between geographical regions, but the majority of the commonly used ingredients do not have anthelmintic properties, thus minimising the anthelmintic potential of any blend that might include one or two items that could be harmful to worms when used on their own. So garam masala is very unlikely to harm helminths.

    • ✅ Garlic (Allium sativum). Garlic compounds have demonstrated anthelmintic activity against flatworms in mice, [470] garlic oil extract has shown anthelmintic effects against Schistosoma mansoni in mice [471] and allicin, the active principle of garlic extract, has also been shown to have anthelmintic properties, although one hookworm host has reported that taking a stabilized allicin extract for several weeks did not kill her worms. [472] Alcoholic extracts of garlic have also shown ‘moderate’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies [473]. However, the exact amount of garlic needed to kill intestinal parasites in humans has not been established. Some sources suggest 1,000 - 4,000 mg per day, using concentrated garlic capsules or tablets, and fresh garlic is said to be more effective than capsules. While chewing three cloves of garlic each day is recommended by some online sources as a treatment for ‘parasites’ in humans, the ingestion of 9 to 14 g of raw garlic daily (54 g total) or 15 to 21 g daily (89 g total) had no evident effect on the egg output of NA in one host, [474] so hookworms may in fact be able to withstand up to 21 grams (approximately 10 cloves) of garlic per day. This means that garlic is unlikely to be an effective killer of mature worms, and its main anthelmintic effect may be to reduce the viability of ova. Cooking may reduce its effect against parasite eggs and larvae, but neither cooked or raw garlic appears to have any adverse effect on the efficacy of a therapeutic hookworm colony.

    • ⚡ Ginger (Zingiber officinale) contains a chemical called zingibain (aka. zingipain, or ginger protease) that has been claimed to dissolve some parasites and their eggs, and numerous hookworm hosts have reported adverse effects after consuming ginger. One subject reported that fresh ginger drinks depress the egg production of his worms and increase his disease symptoms, and another has reported that eating a LOT of ginger 6 weeks post-inoculation caused her hookworm side effects to disappear for a few days, but that these eventually returned. A similar response was noted by someone who was in the habit of adding ginger to sushi platters. She found that this seemed to knock the worms out for a while but that they eventually recovered. [475] Another hookworm host has found that, while consuming powdered or cooked ginger isn’t a problem for him, drinking ginger tea, or any form of kombucha made with raw ginger will stun his worms badly and result in a return of disease symptoms the next day. [476] Someone else, who said that his favorite brand of ginger beer was “pretty spicy”, so was probably made from raw, or only very briefly pasteurized, ginger juice, reported that, after going on a fairly significant binge of the stuff, his worms stopped producing eggs and their benefits diminished. Yet another worm host, who was putting at least a thumb-sized piece of fresh ginger in a smoothie every day, believes this was responsible for actually killing her hookworms. Others have also had issues with ginger, e.g., [477]. However, one subject has reported eating lots of fresh ginger (mostly cooked) without any problems, and several others have reported a similar lack of issues with ginger. [478] [479] [480] One hookworm host says that she regularly takes dried ginger in 1g doses to help with migraines and has not noticed any problems with her worms, [481] and another routinely takes 550 mg of ginger root powder every morning without any obvious effect on either his hookworms or his human whipworms.
    • ⚡ Holy basil (Ocimum tenuiflorum, also known as Ocimum sanctum, tulsi and tulasi/thulasi) is claimed online to be antiparasitic. There is also evidence showing that its essential oil has potent anthelmintic activity against the research worm, C. elegans, [482] and it has shown some activity against the malaria parasite, [483] but this does not necessarily mean that it would harm therapeutic helminths. Eating the raw plant, or drinking tea made from it, may be harmless to human helminths, and one host of both hookworms and human whipworms has reported that she used to drink the tea and eat fresh leaves without issue. [484] However, extracts, tinctures and concentrates of holy basil should be treated with caution.
    • ❓ Horseradish (Amoracia rusticana) has been claimed to be antiparasitic, and it does contain volatile oils, notably mustard oil, which has antibacterial properties and is used as an antiparasitic by some farmers, but evidence about the effects of its use by helminth hosts is lacking.
    • ❓ Mustard. This condiment is claimed to be effective against intestinal worms, including roundworms and threadworms and, in India, mustard oil is used as an antiparasitic by some farmers. However, its action is probably more as a laxative that helps to flush out worms rather than to kill them, and hookworms spend much of their time firmly attached to the gut mucosa. One hookworm host has reported taking about 2 grams of ground mustard seeds most days, with no adverse effect on his worms or their egg production. [485]
    • ✅ Nutmeg (Myristica fragrans, or fragrant nutmeg). This spice, which is obtained by grinding the seed of this tree, (mace is produced from the seed covering) is not harmful to helminths when used as a culinary flavour.

    • ❌ Oregano (Origanum vulgare). Oregano oil, which contains isomeric phenols (primarily carvacrol but also including thymol and limonene), can destroy a number of bacteria, fungi and viruses in dilutions as low as 1/50,000, and is also antiparasitic. It is reported to be effective against protozoan parasites in particular as well as roundworm larvae, and somewhat effective against tapeworms. In one study [486], 57 per cent of adults with intestinal parasites who were treated with 600 mg of oregano oil daily for six weeks experienced total eradication of their parasites. Several hosts of therapeutic helminths have reported adverse effects on their worms after ingesting oregano oil and, in at least two cases, it has resulted in a total loss of worms. However, one subject, who took oil of wild oregano sublingually twice each day for 2 weeks had a stool test sometime after this that was positive for hookworms, so perhaps either the wild form of the herb, or the sublingual route, helped reduce the effect on the worms in this case. Some foods, particularly soft cheeses, may be coated with an antimicrobial film incorporating oregano oil to increase their lifespan, but the amount of oregano involved in this application is unlikely to be a serious threat to helminths. A few oregano leaves eaten with food are less likely to be harmful to human helminths [487], but one host of both hookworms and whipworms has reported that, while there was no immediate effect on his worms when he applied a heavy sprinkling of oregano leaf powder to his food a couple of times in a day, he was later plunged into such a self-critical and depressed mood that, before eventually regaining his usual mental balance, he struggled to do any work for several days.
    • ✅ Saffron This spice is derived from the flower of crocus sativus, commonly known as the "saffron crocus". (See separate entry for this herb.) One hookworm host took a supplement containing turmeric and saffron for 6 weeks without any adverse effect on her colony. [488]
    • ✅ Thyme (Thymus vulgaris). This is also known as Common Thyme, Garden Thyme. Extracts of the leaves, flowering tops and stems are used to kill hookworms, roundworms, threadworms and skin parasites. However, these are unlikely to harm helminths when eaten in reasonable amounts as part of a normal diet. One helminth host has eaten significant quantities of thyme without noticing any adverse effect on her hookworm or whipworm populations.

    • ✅ Turmeric (Curcuma longa), also known as tumeric, generally does not harm human helminths when eaten in food in its natural, whole form, which only contains 3% of the active ingredient, curcumin, [489] or when it is taken in capsules, e.g., as a daily dose of 25 g turmeric (delivering 700 mg curcumin), [490] or as a dose of 580 mg turmeric extract delivering 551 mg curcuminoids daily. [491] There have only been two reports of food quantities of turmeric affecting hookworms. The first of these is here, and the second was by an individual who boiled and ground turmeric powder into a paste and twice drank a large quantity of this (2 tbsp) in her tea. She subsequently experienced a return of her old symptoms, all of which persisted. [492]
      There is much more chance of helminths being harmed when ⚡curcumin is extracted from the turmeric and taken in medicinal quantities. It has been reported that 300 mg of curcumin extract has killed some types of parasites in test tube and animal studies, and that it may temporarily reduce the number of helminth eggs produced. One hookworm host believes that she may have lost her colony as a result of taking a curcumin supplement. [493] However, another hookworm host has reported experiencing a very enjoyable “bounce” (indicating a healthy NA colony) after inoculating, in spite of taking 250 mg of curcumin daily. [494] As with other substances that can affect hookworms, the effect of curcumin may depend to some extent on the strength of the individual host’s immune response, as well as on the form of curcumin used.
      Nano-emulsified curcumin appears to be more effective, therapeutically, [495] so may also have an increased detrimental impact on helminths. Another high-potency form of curcumin is BCM-95, which has been shown to be 6.93 times more bioavailable than normal curcumin, [496] and this product may have been responsible for a sudden return of disease symptoms for one hookworm host. [497] The beneficial effect of curcumin can be increased 5- to 10-fold by adding ascorbic acid (vitamin C) [498] so taking this vitamin along with curcumin might make it possible to use curcumin therapeutically in much smaller doses (ascorbic acid does not harm helminths), although this vitamin may increase curcumin's adverse effect on helminths if the quantity of the spice is not reduced proportionately.
    • ❓ Turmeric, Wild (Curcuma aromatica). While alcoholic extracts of the rhizomes of wild turmeric have shown ‘moderate’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies and extracts of the rhizomes may therefore also have an adverse effect on other helminths, it is likely that consuming dietary amounts of this spice will do no harm to human helminths, though this has not yet been confirmed.

    Herbs and medicinal plants

    The majority of the herbs listed below have been reported, or claimed, to be antiparasitic, although clinical evidence for this effect is lacking in many cases. Furthermore, where they are indeed antiparasitic, herbs may be more effective against types of parasite other than helminths, although this is not to say that they may not also have some detrimental effect on helminths.

    Where a herb is effective against helminths, quite large quantities may be required to dislodge or kill the worms, but consuming some of these herbs on a regular basis, or in the form of concentrates, extracts, tinctures and oils that are directed at the gastrointestinal tract may weaken therapeutic helminths, making them less effective.

    It should not be assumed, from a cursory glance at the following list, that most herbs are potential threats to human helminths. This list only contains those herbs that have been mentioned specifically by self-treaters, and there are less than 100 herbs in the entire list. Many thousands of compounds are used in herbal medicine, so it will usually be possible to find a more hookworm-friendly alternative for whatever purpose one has in mind.

    Many of the herbs listed below are used to treat a number of conditions in addition to parasite infections, so might be encountered in a range of herbal remedies. It may therefore be advisable for any helminth host who contemplates taking any herbal remedy to check its ingredients against the list below and, where an ingredient appears to have antiparasitic properties, to seek an alternative, if possible.

    When taking herbs, an additional risk arises from the fact that the majority of herbal products contain unlisted ingredients, in view of which it would seem wise to employ a cautious approach with all herbal products.

    List of herbs and medicinal plants

    • ⚡ Acacia. Also known as thorntree, whistling thorn, or wattle. One example of this genus of shrubs and trees, (Acacia mearnsii, previously known as Acacia molissima) contains tannin extracts that have been found to have an anthelmintic effect on Haemonchus contortus and Trichostrongylus colubriformis in lambs. For a more detailed consideration of the possible effects of tannins on nematodes, see these papers: [499] [500].
    • ⚡ Albizia lebbeck. Alcoholic extracts of the bark of Albizia lebbeck have shown ‘moderate’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[501], so extracts of the bark may also have an adverse effect on other helminths.
    • ✅ Aloe vera. This contains an antimicrobial agent, saponin, and the laxative chemical, aloin. Aloe is perhaps the best known laxative in history, and it may be this, rather than any actual anthelmintic property, that is the source of its reputation for expelling parasites. While extracts have been reported as showing inhibitory effects on two roundworm species, these only affected the hatching of eggs and the development of larval stages. One aloedrinking helminth host has reported that his habit has had no obvious detrimental effect on his worms, and another hookworm host failed to notice any adverse effects after drinking pure aloe juice or gel daily for a week or two, or after drinking one of the 16oz sweetened/flavored drinks. [502]
    • ⚡ Alpinia calcaratta. Alcoholic extracts of the rhizomes of Alpinia calcaratta have shown ‘moderate’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[503] so extracts of the rhizomes may also have an adverse effect on other helminths.
    • ❌ Alpinia galanga. Alcoholic extracts of the rhizomes of Alpinia galanga have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[504] so extracts of these rhizomes may also have an adverse effect on other helminths.
    • ❌ Andrographis paniculata (also known as creat, green chiretta; active component: andrographolide). Alcoholic extracts of Andrographis paniculata have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies. [505] Andrographolide has also shown significant ovicidal and larvicidal activity against the human hookworm, Ancylostoma duodenale. [506]
    • ⚡ Anise (Pimpinella anisum). Also known as aniseed. Anise oil may have modest antiparasitic effects and has been recommended by some practitioners as a treatment for mild intestinal parasite infections, but there have not been any reports about this from helminth hosts.
    • ❌ Arecoline. This odourless oily liquid derived from the areca nut, fruit of the areca palm (Areca catechu), has long been used medicinally as an anthelmintic.
    • ✅ Ashwagandha (Withania somnifera). Also known as Indian ginseng, poison gooseberry, and winter cherry. Several hookworm self-treaters have reported using ashwagandha without issue. One NA host has reported that taking 380mg ashwagandha root and 95mg ashwagandha root extract twice each day for a month appeared not to affect her worms. [507] Someone else takes 450 mg ashwagandha x2 per day and reports that his NA are fine, [508] and a third hookworm host has taken 500mg ashwagandha twice a day without any adverse effect on their worms. [509] A naturopathic doctor has also reported that ashwagandha is OK to take while hosting hookworms, [510] and someone who is self-treating with human whipworms (TT) has reported that taking a teaspoon of ashwagandha every day did not have any apparent effect on this species. (Also see the list of concerns and contraindications regarding Ashwagandha in this Facebook post.)
    • ⚡ Balmony (Chelone glabra) A decoction or tincture prepared with all parts of the plant is said to be a highly effective remedy for parasites, including intestinal worms. It was used traditionally by Native Americans to expel worms and is used today in proprietary parasite cleansing preparations.
    • ⚡ Barberry (Berberis vulgaris) contains ⚡berberine.
    • ⚡ Beleric (Terminalia bellirica/Terminalia bellerica). Also known as bastard myrobalan or Bahera. This herb is said to be anthelmintic, but this reputation may be due more to its laxative properties than any actual worm-killing potential.
    • ⚡ Berberine is an amebicide which, in concentrated form, has been shown to kill various parasites such as tapeworms and giardia and to have anti adhesive effects which prevent pathogens from adhering to intestinal mucosal cells. One hookworm host who took one gram of berberine three times a day has reported being pretty sure that this killed his worms. [512]
    • ✅ Bidens alba has been reported as not being a problem for helminths.
    • ❌ Biocidin is a proprietary herbal blend that includes oregano oil and black walnut, both of which are known to have anthelmintic effects. See the separate entries for these two herbs.

    • ❌ Bitter cumin (Centratherum anthelminticum). As its Latin name suggests, the seeds of this member of the daisy family are considered anthelmintic.
    • ⚡ Bitter melon (Momordica charantia) is used as a folk medicine to treat gastrointestinal diseases, and extracts have shown activity against the nematode worm C. elegans in test tube studies[513].
    • ⚡ Black walnut (Juglans nigra). Also known as eastern black walnut. This nut has been claimed to be one of the best overall dewormers for humans, killing both the adult and developmental stages of at least 100 parasites. However, according to the American Cancer Society, available scientific evidence does not support claims that the hulls of the black walnut remove intestinal parasites. Although this nut has a strong flavour, it is actually quite rare, as its shell is hard and difficult to remove. It is therefore only likely to be encountered in expensive baked goods. Most commercially available walnuts are hybrids of the ✅English walnut.
    • ✅ Boswellia is a fragrant resin, extracts of which are used in pharmacology, particularly as anti-inflammatories. There have been no suggestions that boswellia might be a problem for helminths, and its anti-inflammatory action could be supportive of the beneficial effects that helminths produce, as demonstrated in Crohn’s disease in this study. [514]
    • ❌ Breadfruit (Artocarpus altilis)) A methanol-water fraction of this plant has been shown to inactivate 50% of the larvae of the helminth, Strongyloides stercoralis, in approximately 9.5 hours, compared with 35 hours taken by albendazole. Aqueous methanol extracts took 49 hours. [515]
    • ❌ Calamus/Sweet Flag (Acorus calamus) The bitter element in sweetflag, acorin, is claimed to have anthelmintic properties, and the standardised rhizome extract of A. calamus has been shown to have significant dose-dependent effects against the rat tapeworm, Hymenolepis diminuta, so may also harm other helminths. [516]
    • ✅ Castor oil. This will not kill helminths, though it may help to expel worms after eradication, and this is probably the reason for its antiparasitic reputation and it's use in para-cleanse products.
    • ✅ Cat’s Claw is a common name for several plants, but it appears to be applied particularly to two species - Uncaria tomentosa (samento), most commonly used in the US, and Uncaria guianensis, typically used in Europe. Medicines made from the root and bark of these species have been claimed online to facilitate the elimination of intestinal parasites, but WebMD states that there is insufficient evidence for its effectiveness against parasites, [517] and one hookworm host has taken up to 2000-2500 mg of Uncaria tomentosa daily in raw form for months with no adverse effects on his NA. He was even able to incubate fresh larvae from his colony during this period. [518]
    • ⚡ Chaparral (Larrea tridentata). Some cultures customarily bathe with chaparral annually to eliminate skin parasites, but use of the leaves of Larrea species is not advised, due to the possibility of damage to the liver and kidneys.
    • ❌ Chicken weed (Salvia serotina), also known as Littlewoman, has been shown to inactivate 50% of the larvae of the helminth, Strongyloides stercoralis, in approximately 20 hours, compared with 35 hours taken by albendazole. [519]
    • ✅ Chinese knotweed (Fallopia multiflora, also known as Reynoutria multiflora (Thunb.) Moldenke, Polygonum multiflorum Thunb., tuber fleeceflower) has been shown to make one nematode live longer. [520]
    • ❌ Cinnamomum verum. This was previously known as ⚡C. zeylanicum and also referred to as ⚡"true cinnamon", ⚡Ceylon cinnamon or ⚡Sri Lanka cinnamon. Alcoholic extracts of the bark of ⚡C. verum have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[521] so extracts of the bark may also have an adverse effect on other helminths. The spice, ⚡cinnamon is typically derived from related species within the genus, Cinnamomum.
    • ❌ Citrus decumana. Alcoholic extracts of the rind of Citrus decumana have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[522], so extracts of the rind may also have an adverse effect on other helminths. Citrus decumana is a relative of the common ✅grapefruit (citrus paradisi) and, while commercially available forms of ⚡grapefruit seed extract have a potential to harm human helminths (due to the typical addition of synthetic adulterants), there is no evidence that the flesh of the grapefruit has any adverse effect on helminths.
    • ❓ Crocus sativus. Also known as autumn crocus and saffron crocus, this plant is best known for the spice saffron, which is produced from parts of the plant's flowers. (See separate entry for the spice.) Two important bioactive compounds of Crocus sativus (crocin and safranal), and some semi-synthetic derivatives of safranal, have been found to be effective against some types of parasite (Helicobacter pylori, the malaria parasite, plasmodium, and Leishmania). However, there have been no reports of adverse effects on therapeutic helminths.
    • ⚡ Curled/Curly Mint (Mentha spicata variety crispii/Mentha crispa/Mentha crispata). This cultivar of Spearmint (Mentha spicata), and close relative of Peppermint (Mentha piperita) (see Peppermint reference), may be effective against giardia and amoeba infections, and may have anthelmintic properties. It was once listed on a website under, “herbs that your health care provider might consider using to treat intestinal parasites.” [523]
    • ❌ Desmodium triflorum. Alcoholic extracts of Desmodium triflorum have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[524], so it’s extracts may also have an adverse effect on other helminths, possibly due to it containing a significant amount of a powerful psychedelic substance which might cause hookworms to lose their grip and be expelled.
    • ✅ Echinacea. This is not a single plant but a genus containing several different species. In the case of medicinal products labelled as echinacea, these are likely to have been obtained from one or more of the following sources: E. purpurea, E. angustifolia or E. pallida. Such products may also be either extracts, or the expressed juice of, different plant organs (e.g., roots and leaves) resulting in different products having very different chemical compositions. However, there have been no reports of human helminths being harmed by taking any echinacea products. As the polysaccharides found in Echinacea purpurea roots have been shown to have anti-inflammatory effects, water extracts of these roots may be of benefit to helminth hosts who require a supplementary anti-inflammatory.
    • ❌ Elecampane. (Inula helenium, also known as alant, aster helenium, aster officinalis, aunée, aunée Officinale, elfdock, elfwort, enule campagne, grande aunée, helenio, helenium grandiflorum, horse-elder, horseheal, horse-heal, Indian elecampane, inule aulnée, inule aunée, inule hélénie, Œil-de-cheval, scabwort, velvet dock, wild sunflower and yellow starwort.) According to WebMD, this herb can be used to kill intestinal worms, including hookworms and whipworms. [525] One hookworm host who took some drops containing several herbs that included elecampane suffered “vicious” diarrhoea for 16 hours, after which she reportedly lost the benefits from her worms.
    • ❌ Erba ruggine (Ceterach officinarum) is listed on one website under, “Herbals that may kill and expel worms.” [526]
    • ❓ Eurycoma longifolia (commonly called tongkat ali, pasak bumi or malaysian ginseng). The root of the plant is used in Indonesia and Malaysia as a health tonic, the benefits of which are claimed to include the treatment of intestinal worm infections. However, one hookworm host has reported using 100mg tongkat ali extract, containing 10% eurycomanone, for 60 days without any adverse effect on his worm colony. [527]
    • ❓ Frankincense (olibanum). This aromatic resin is used in incense and perfumes, and is obtained from trees in the Boswellia genus. There have been no reports about it having any effect on helminths.
    • ❌ Gentian root. The root and underground stem of Gentiana lutea (yellow gentian) are said to assist in expelling 'harmful organisms'. One subject has reported that taking a form of gentian in large quantity on a daily basis for sinus inflammation was responsible for the loss of his whipworms, although possibly not his hookworms.
    • ✅ Ginkgo biloba. There has been one hint that ginkgo may have caused a mild reduction in hookworm benefits, but this was by no means certain, and two other helminth hosts have reported taking ginkgo regularly with no apparent adverse effect on their worms. (Also see Anticoagulants.)
    • ⚡ Goldenseal (Hydrastis canadensis). This contains berberine.
    • ❌ Goosefoot (Chenopodium ambrosioides) is widely used to deworm animals, and the Japanese make a dewormer tea with the leaves. Goosefoot oil is a highly efficient anthelmintic, and extremely toxic. Human consumption of this herb has often produced strong side effects such as nausea and headaches, and even death in some cases.
    • ⚡ Hagenia (Hagenia abyssinica). Also known as African redwood, brayera, cusso, hagenia, and kousso, hagenia has been used as a treatment for the pork tapeworm (Taenia solium), but is often only partially effective in this case.
    • ⚡ Haritaki (Terminalia chebula). Also known as Yellow Myrobalan, Chebulic Myrobalan, Kadukkai, Silikha, Himmej, Karakkaya and A-ru-ra. The fruits are reportedly anthelmintic, but this reputation may be due more to its laxative properties than any actual worm-killing potential.
    • ❌ Houttuynia cordata Thunb (HCT), also known as fish mint, fish leaf, rainbow plant, chameleon plant, heart leaf, fish wort, Chinese lizard tail, and bishop's weed. The leaf extract of this Thai herb, which is used as an anti-inflammatory medication in the treatment of rheumatoid arthritis [528] has shown anthelmintic activity against Hymenolepis diminuta, especially the adult worms. [529] The entire Saururaceae plant family is considered to have anthelmintic properties and is used by the Naga tribes in Northeast India to treat intestinal worm infections in general. It may therefore also have a potentially harmful effect on other therapeutic helminths.
    • ❌ Hydnocarpus wightiana. Alcoholic extracts of the seeds have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[530], so extracts of the seeds may also have an adverse effect on other helminths.
    • ⚡ Hyssop (Hyssopus officinalis). The leaf contains an essential oil with antiseptic properties that has been claimed to have anthelmintic effects, but, if eaten as a herb, hyssop is unlikely to harm helminths.
    • ❌ Ipecac, syrup of. Alkaloids in ipecac, including emetine, are reported to kill several types of parasite, particularly amoebae, but also pinworms and tapeworms, although the amounts needed to produce these effects in humans are generally high and can lead to severe side effects. Emetine and the somewhat safer form, Dehydroemetine, are usually reserved for rare cases of people infected with amoebae who are not cured by using anti-amoeba drugs.
    • ⚡ Juniper (Juniperus communis) is a very effective natural antibiotic which is also said to have deworming properties, notably against liver fluke, and is used to treat worm infestations in animals. Juniper is also used as the primary flavouring in gin, but there have been no reports of any harm coming to helminths as a result of drinking gin.
    • ❌ Kaempferia galanga. Alcoholic extracts of the rhizomes have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[531], so extracts of the rhizomes may also have an adverse effect on other helminths.
    • ⚡ Kava/kava-kava (Piper methysticum). According to this report[532], the active ingredients in Kava tea (kavalactones) can create mild sedation without disrupting cognitive function, and can act as a muscle relaxant, with higher doses having an effect similar to that of a local anaesthetic. If Kava tea were to “relax” hookworms, this might conceivably affect their ability to keep their grip on their host’s mucosa, which might lead to them being expelled, especially if the drink is taken in quantity or at higher strength.
    • ❓Lactuca virosa Also known as wild lettuce, bitter lettuce, laitue vireuse, opium lettuce, poisonous lettuce, tall lettuce, great lettuce and rakutu-karyumu-so. While this herb is claimed by a few sources online to have an anthelmintic effect (e.g., [533] (PDF)), there have been no reports of it having an adverse effect on either NA or TT. However, it is worth noting that Lactuca virosa can cause toxic effects in those who consume it. [534]
    • ❓Lemon balm (Melissa officinalis), a member of the mint family also known as balm, common balm or balm mint. This has been found to exhibit high nematicidal activity against the roundworm, Meloidogyne incognita [535] and, when included with other herbs, to help reduce the number of pigs infected with the roundworm, Ascaris suum. [536]. It is also listed as a vermifuge on some herbal websites, but there have been no reports thus far of lemon balm affecting either NA to TT.
    • ✅ Liquorice/licorice, the root of Glycyrrhiza glabra. One hookworm host has reported [537] taking “lots” of deglycyrrhizinated licorice (DGL) with no ill effect on his worms. And another NA host has reported taking liquorice extract without any problems. [538] Liquorice extracts may be useful as an adjunctive therapy for psoriasis, for colitis and possibly other autoimmune diseases, but excessive consumption of liquorice containing glycyrrhizin/glycyrrhizic acid may not be wise. The World Health Organization's recommended daily maximum for liquorice is 2 mg/kg.
    • ❌ Lippia nodiflora. Alcoholic extracts of this have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[539], so these extracts may also have an adverse effect on other worms.
    • ❌ Love weed (Cuscuta americana) extract has been shown to inactivate 50% of the larvae of the helminth, Strongyloides stercoralis, in approximately 2 hours, compared with 35 hours taken by albendazole. [540]
    • ⚡ Male fern (Dryopteris filix mas). Also once known as worm fern! The rhizomes and young shoots (fiddleheads) of the male fern have antiparasitic properties and the root has been used to treat tapeworms. However, this herb is seldom used today due to its side effects (e.g. headaches and nausea) and because large doses are extremely poisonous and may induce liver damage. The North American equivalent of the male fern is the evergreen marginal shield-fern (Dryopteris marginalis).
    • ✅ Mastic gum Mastic (plant resin), also known as tears of Chios, is excreted by the resin glands of certain trees. One NA host has reported chewing mastic gum every day for a couple of months, and said that even chewing it until it dissolved had no harmful effect on his colony. [541]
    • ✅ Milk Thistle (Silybum marianum). Also known as cardus marianus, blessed milk thistle, Marian Thistle, Mary Thistle, Saint Mary's Thistle, Mediterranean milk thistle, variegated thistle and Scotch thistle. There have been no adverse reports about this herb from worm hosts, and there are no reasons to believe that it might harm human helminths.
    • ❌ Mimosa pudica Also known as shy plant, sensitive plant, sleepy plant, action plant, touch-me-not, and shameplant, this popular houseplant is a tropical fern, whose leaves close rapidly when touched. Aqueous methanol extracts of the leaves of this plant showed a similar ability as the anthelmintic drug, levamisole, to inactivate larvae of the helminth, Strongyloides stercoralis. [542] While there have been no reports to date of this plant having a harmful effect on any of the therapeutic helminths, it has been used extensively as an anti-parasitic agent in traditional and Ayurvedic medicine, so clearly has significant potential as an anthelmintic.
    • ❌ Morinda citrifolia, also known as great morinda, Indian mulberry, beach mulberry and cheese fruit). Alcoholic extracts of the tender leaves of M. citrifolia have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies [543], so the same extracts may also have an adverse effect on other helminths.
    • ❌ Mugwort (Artemisia vulgaris). Also known as Moxa, Common Wormwood, Traveler's Herb and Felon Herb, and a relative of wormwood (Artemisia Absinthium), mugwort is said to make short work of roundworms, pinworms and tapeworms.
    • ⚡ Myrrh. This has antiparasitic effects against various schistosome species and the liver fluke, Fasciola hepatica.
    • ❌ Neem (Azadirachta indica). Also known as margosa, nimtree and Indian lilac. Ayurvedic medicine holds that Neem is the best herb for treating worms and other parasites and that a simple decoction of Neem leaves can kill all parasites present in the intestines. Neem extract has also been shown to be more effective against rodent helminths than standard chemotherapy with albendazole or mebendazole.
    • ✅ Nettle, stinging (Urtica dioica) Stinging nettle was found to have anthelmintic effects in one study [544] but this was carried out in vitro, using a nettle extract, and in a non-therapeutic worm (the Indian earthworm) so these findings are not directly applicable to humans using human-adapted helminths. There have been no reports of any adverse effect on human helminths after their hosts have drunk nettle tea, and one hookworm host has reported regularly eating nettles without issue. [545]
    • ❓ Noni (Morinda citrifolia). See the separate entry for Morinda citrifolia, above. A test tube study [546] found that noni helps to eliminate the roundworm, Ascaris lumbricoides, but, so far, no one hosting therapeutic helminths has reported using this.
    • ❌ Olive leaf extract (Olea europaea). Known as 'nature's antibiotic', this extract contains a component called oleuropein that is able to degrade pathological microorganisms of all kinds, and inhibit or kill many types of intestinal parasites including flatworms, hookworms, roundworms and tapeworms. Two subjects have reported losing their helminths after taking this.
    • ⚡ Oregon grape (Berberis aquifolium/mahonia aquifolium) contains berberine.
    • ❌ Palmarosa (Cymbopogon martinii). Also known as Indian geranium, gingergrass and rosha or rosha grass. This may kill helminths.
    • ❓ Pau d’arco. Also known as lapacho, red lapacho or taheebo, pau d'arco is a tea made from the inner bark of Handroanthus impetiginosus (Pink Ipê), which is claimed to have antiparasitic effects. Its main active ingredients are lapachol, quercetin and other flavonoids. Having expectorant properties, it is used as a herbal remedy for colds, flu and smoker's cough. However, lapachol is rather toxic and is more often used topically, for example as as antibacterial or pesticide. There have been no reports from helminthic therapy self-treaters to suggest what effect, if any, drinking pau d'arco might have on therapeutic helminths.
    • ❌ Pennyroyal (Mentha pulegium). A member of the mint family, also known as European pennyroyal, pennyrile, squaw mint, mosquito plant and pudding grass. This plant has anthelmintic properties. [547]

    • ⚡ Peppermint (Mentha piperita, aka M. balsamea Willd) is used as an ingredient in some antiparasitic preparations. Several helminth hosts have strongly suspected that peppermint oil killed their worms, and one found he could not establish a worm colony at all while taking peppermint oil. Even eating a lot of peppermints caused a return of disease symptoms for one hookworm host. [548] However, a number of others, who have used peppermint oil as a treatment for IBS, have noticed nothing untoward, and one subject has reported taking peppermint oil continuously without issue. Only the oil has been implicated. Eating ✅peppermint leaves, or drinking tea made from them, should not be a problem, as was found by one hookworm host who has reported drinking lots of peppermint tea without hurting her worms. [549] Peppermint extract has also been reported not to be a problem for another hookworm host. [550]
    • ❌ Pollia serzogonian. Alcoholic extracts of the rhizomes of ⚡P. serzogonian have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[551] so extracts of the rhizomes may also have an adverse effect on other helminths.
    • ❌ Quassia (Picrasma excelsa) has, anecdotally, been used successfully to treat threadworms and roundworms, as well as giardiasis, especially when used as an enema. It is a favoured botanical anthelmintic because of its low toxicity.
    • ✅ Rhodiola rosea. Two hookworm hosts have reported taking rhodiola without any adverse effect on their colonies. [552] [553]
    • ✅ Rosemary has been reported not to be a problem for helminths.
    • ❌ Sage (Salvia officinalis) was used traditionally as a treatment for intestinal worms and some forms of sage are still often included as an ingredient in modern proprietary antiparasitic remedies. Also one NA host has reported that drinking sage-containing teas stunned his colony for nearly a month. [554] However, the use of sage leaves as a culinary herb may not pose a problem for helminths, but there has not yet been sufficient feedback to be certain about this. Sage oil is likely to be much more of a problem for helminths, and one helminth provider cautions against the use of any concentrated form of sage.
    • ❌ Salvadora persica (also known as arak, jhak, pīlu, Salvadora indica, toothbrush tree and mustard tree). Extracts of the root of this plant have been found to have powerful anthelmintic activity in a model worm. [555]
    • ✅ Sambucus nigra, also known as European elderberry, European black elderberry, elder, European elder, elderberry, black elder, and the branded product, Sambucol. Several NA hosts have taken different forms of black elderberry liquid with no harm to their NA. [556] Elderberry is known to stimulate the immune system, so might increase the symptoms of autoimmune diseases [557] [558] which may give the impression that it has affected a worm colony when it hasn't. Also see the comments here and here.
    • ❌ Santonin is extracted from the dry buds of the desert plant Eurasian wormwood (Artemisia cina). It acts against most parasites except Echinococcus, and is used to treat roundworms.
    • ⚡ Saw palmetto (Serenoa repens). Also known simply as Serenoa, or Sabal serrulatum. One individual has reported an inability to maintain a hookworm colony while taking this herb, but had success once the herb was discontinued.
    • ✅ Shilajit (mumijo). One hookworm host has taken this without any apparent adverse effect on his colony. [559]
    • ❓ Slippery elm (ulmus rubra). This is listed on at least one website[560] as a herb that may be helpful in treating various types of parasitic worms, including hookworms, but the only report[561] so far was from a hookworm host who said that she used a small amount of slippery elm powder on a few occasions without noticeably affecting her worms.
    • ⚡ Southernwood (Artemisia abrotanum) This European flowering plant has demonstrated effects against some helminths. It is also known as old man, boy's love, oldman wormwood, lover's plant, appleringie, garderobe, Our Lord's wood, maid's ruin, garden sagebrush, European sage, sitherwood and lemon plant. Spondias (Spondias mombin or Spondias purpurea var. lutea) This tropical fruit, which is also known as hog plums, Spanish plums, libas in Bikol, golden apples and mombins, may have anthelmintic effects.
    • ✅ St. John’s Wort (Hypericum perforatum). It had been considered conceivable that some of the constituents of hypericum might have an adverse effect on helminths if taken in isolation and in large quantities (e.g., hyperforin, which has demonstrated some antibacterial properties, and hypericin, which has shown both antibacterial and antiviral activity), but there have been no reports of adverse effects on human helminths from any hypericum product in more than a decade.
    • ⚡ Sweet Annie (Artemisia annua). Also known as sweet wormwood, sweet sagewort and annual wormwood. Both the herb and the pure form of its active ingredient, the sesquiterpene lactone, artemisinin, have been used traditionally to treat malaria and intestinal parasites. Artemisinin is a potent anthelmintic and has been shown to be effective against schistosomes. [562]
    • ❌ Tansy (Tanacetum vulgare), also known as common tansy, cow bitter, bitter buttons and golden buttons, is highly toxic to intestinal parasites and, for centuries, tansy tea has been prescribed by herbalists to expel worms. One study found that both the crude hydroalcoholic extract of T. Vulgare, and its essential oils, possess significant activity against adult S. mansoni worms, and the activity of the essential oils may be related, at least in part, to monoterpene thujones, which were detected as major constituents of the essential oils. [563]
    • ⚡ Tea tree oil (Melaleuca alternifolia) has been claimed to kill intestinal worms, including roundworms, tapeworms and hookworms, and its anthelmintic activity has been investigated. [564] The use of tea tree products may therefore have adverse effects on therapeutic helminths.
    • ❌ Tephrosia purpurea. Alcoholic extracts of ⚡T. purpurea have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[565], so these extracts may also have an adverse effect on other helminths.
    • ❌ Thymol, a monoterpene phenol found in oil of thyme and oregano oil, has antimicrobial and antifungal properties and is said to be highly effective against hookworms. It can also be toxic and has caused fatalities in children.
    • ⚡ Usnea are lichen species with powerful antibiotic and antifungal properties. Usnea florida extract has been found to have a dose-dependent anthelmintic effect against the nematode worm, Trichinella spiralis.
    • ❓ Uva-ursi. (Arctostaphylos uva-ursi). One of several related species referred to as bearberry, uva-ursi contains the glycoside arbutin, which has antimicrobial properties. There are claims online that uva-ursi is also anthelmintic, but, so far, there have been no reports of its effect on therapeutic helminths.
    • ✅ Valerian (Valeriana officinalis). One hookworm host has reported taking valerian tincture without noticing any interaction with her worms. [566]
    • ⚡ Vasaka (Justicia adhatoda). Also known as Malabar Nut, Adulsa, Adhatoda and Vasa. From the same family as Adhatoda zeylanica. The leaves (which contain vasicine, an alkaloid with significant antimicrobial activity), root, bark, fruit, and flowers are all said to help in removing intestinal parasites.
    • ❌ Vernonia amygdalina Wild Mahale chimpanzees control parasite-related diseases by ingesting the pith of this plant, [567] and some human tribal communities use concoctions of the plant for the same purpose. [568]
    • ❌ Vervine (Stachytarpheta jamaicensis) (Also known as, blue porterweed, blue snake weed, bastard vervain, Brazilian tea, Jamaica vervain and light-blue snakeweed. Vervine extract has been shown to inactivate 50% of the larvae of the helminth, Strongyloides stercoralis, in approximately 81.5 hours - not much more than the anthelmintic drug, thiabendazole, which took 74 hours. [569]
    • ✅ Vitaxyn. Alcoholic herbal concoctions with this name, or referred to as "Tancosan", are thought unlikely to be a problem if taken at the recommended dosage and unless they contain some other ingredient that is known to be harmful to helminths. A product called "Tancosan" was taken by one hookworm host for over 2 years without any obvious adverse effect on her worms.
    • ✅ Vitex agnus-castus. Also known as vitex, chaste tree, chasteberry, Abraham's balm, lilac chastetree and monk's pepper. One hookworm host has taken 1000 mg of dried vitex agnus castus each day for many months without any noticeable ill effect on her worms. [570]
    • ⚡ White walnut (Juglans cinerea). Also known as Butternut. This nut has been used to expel rather than kill worms, although both root bark and leaves have been used in combination with an equal amount of ❌Mugwort to treat worms in children.
    • ❌ Wild rue (Peganum harmala). Also known as Esfand, Syrian rue, African rue and harmal. Its powdered seeds were used traditionally to expel tapeworms.
    • ❌ Wood betony (Stachys officinalis). Also known as betony, purple betony, bishopwort, or bishop's wort. A tea made from this may kill helminths.
    • ✅ Woodsorrel (Oxalis) has been reported[571] as not being a problem for worm hosts when eaten as a food.

    • ❌ Wormseed (Dysphania ambrosioides, formerly Chenopodium ambrosioides). Also known as epazote, goosefoot, Jesuit's Tea, Mexican Tea, Herba Sancti Mariae and paico. Wormseed is a traditional herbal remedy used in the tropics for expelling roundworms, hookworms and tapeworms. The oil, leaves or whole plants can be used, but one study[572] found that the powdered herb did not effectively eradicate hookworms, roundworms, or whipworms.
    • ❌ Wormwood (Artemisia Absinthium). Also known as common wormwood, green ginger or grand wormwood, this herb was used traditionally as an anthelmintic. Other members of the genus, artemisia, that were traditionally used as anthelmintics include white wormwood (Artemisia herba-alba), Eurasian wormwood (Artemisia cina) commonly known as santonica, Levant wormseed and wormseed, and Russian wormwood (Artemisia vestita) also known as Buer, Chamariya, Drubsha, Ganga Tulsi, Kubsha, Kundiyaa, Kundja and Seski. [573]
    • ✅ Yerba mate (also known as erva-mate). No adverse reports have appeared so far about the effect of this herb on human helminths, or of the beverage made from it, known as mate, maté, Chimarrão, cimarrón, Tererê or Tereré.
    • ❌ Zingiber zerumbet. Alcoholic extracts of the rhizomes of Z. zerumbet have shown ‘good’ anthelmintic activity against the human roundworm, Ascaris lumbricoides, in test tube studies[574], so these extracts may also have an adverse effect on other helminths.


    Fungi

    • ❓ Amanita muscaria is a psychoactive and poisonous fungus with several known variations, or subspecies. One hookworm host has reported eating "a couple of hats (5-6 max)" on a few occasions without any effect on his NA that he can remember. [575]
    • ❌ Chaga mushroom (Inonotus obliquus). This fungus, which grows singly on birch and other trees, is claimed, in several places online, to be effective against intestinal parasites, and it has been used for this purpose in the traditional folk medicine of Russia and Eastern Europe. One hookworm host thinks that drinking tea made from chaga mushrooms may have caused the failure of several hookworm incubations, [576] however, another NA host has taken 200 mg+ daily of the chaga-containing Sacred 7 Mushroom Extract Powder blend (chaga, cordyceps, lion's mane, maitake, reishi, shiitake, & turkey tail) with no apparent ill effect on his NA. [577]
    • ✅ Cordyceps One NA host took 1/4-1/2 teaspoon cordyceps 5 times a week for months with no ill effect on his helminths. [578]
    • ❌ Fomitopsis betulina. This edible fungus, which is usually found on birch trees, was previously known as Piptoporus betulinus, and is commonly known as the birch polypore, birch bracket, or razor strop. Wikipedia reports that F. betulina has been widely used in traditional medicines, and a paper referenced in the Wikipedia article suggests that polyporenic acid, found in the fruit body of the fungus, may be poisonous to the human whipworm, Trichuris trichiura (TT). [579] F. betulina also contains toxic resins and an active compound, agaric acid, which are powerful purgatives that can result in strong though short-lived bouts of diarrhoea. [580]
    • ✅ Lingzhi mushroom (also known as Reishi). Several self-treaters have taken Reishi mushrooms or their extracts, e.g, [581], and there have been no reports of any adverse effects on NA or TT. One user says he consumes moderate doses of reishi [582] and another has even successfully used Reishi (Reishi Mushroom extract powder, 1000 mg 2x daily) to treat “worm flu”. [583]
    • ✅ Lion’s mane mushroom (Hericium erinaceus) Also known as yamabushitake (= ‘mountain priest mushroom’), bearded tooth fungus and bearded hedgehog. One NA host took 1/4-1/2 teaspoon lion's mane 5 times a week for months with no ill effect on his helminths. [584]

    Miscellaneous

    • ❌ Diatomaceous earth (DE). This is made from the fossilized remains of tiny, aquatic organisms called diatoms which are mined from ancient sea beds and ground into a fine powder to produce food grade or medical grade diatomite. The finer grade diatomites are used as an insecticide and are also employed to deworm pets and humans. They are believed to work by dehydrating the organism, although the sharp edges of the particles may also be damaging to tiny creatures. A daily dose of one heaped teaspoon of DE has been claimed to be effective for human worm control, and one hookworm host has reported that three doses, of approximately one teaspoon each, quickly wiped out her colony and caused the return of all the symptoms of her disease. Someone who actually wanted to terminate a hookworm colony has said that small amounts of DE did not do this for her, but that taking 1 tablespoon each day for three days did completely eradicate a hookworm colony. [586]
    • ❓ Clay (bentonite, kaolin, etc.) Some clays have antibacterial properties [587] [588] that vary by type, and some have been claimed to be natural parasite preventives that inhibit the reproduction of organisms. One helminth provider at one time advised against the use of clay while hosting worms, but clay is now thought much less likely to harm human hookworms and whipworms than it is tapeworms, and it may in fact not have any adverse effect at all on any type of therapeutic helminth. Someone has reported taking a "scant soup spoonful" of montmorillonite clay slurry daily for quite long periods up to 3 or 4 months with no obvious adverse effect on her NA. [589]

    • ✅/❌ Diarrhoea/diarrhea While it is possible to lose hookworms to diarrhoea, this is only likely if the diarrhoea is very severe, or if it is severe and prolonged, i.e., lasting for several weeks. There is a description of one individual’s experience of losing a hookworm colon to very severe diarrhoea here.
    People who get diarrhoea/diarrhea as a side effect following their first inoculation with hookworms do not lose all their worms as a result of this, and hookworms are able to withstand the typical colonoscopy prep. See Laxatives.
    It would seem logical to assume that hookworms might be better able to resist being flushed out after the point at which they attach to the gut wall, which is towards the end of the third week post inoculation.
    While adult hookworms do move around to feed, and are therefore theoretically more likely to be lost if diarrhoea strikes while they are on the move, this is unlikely to lead to any significant loss.
    Human whipworms are unlikely to be dislodged by diarrhoea once these are mature and embedded in the colonic mucosa, but they could could potentially be flushed out before this, especially around 21-22 days post inoculation. After 28 days, human whipworms should not be affected at all by diarrhoea.
    • ✅ Fasting. This will not harm human helminths because they feed from their host’s blood (hookworms), or from their intestinal tissue (whipworms). Fasting is also unlikely to have any detrimental effect on the rat tapeworm, Hymenolepis diminuta (HDC), even though this species normally lives on carbohydrates consumed by their host. HDC can apparently also live off glycoproteins secreted in the gut.
    • ✅ Fever. Running a fever for several days will not harm helminths.
    • ✅ Infrared sauna. Two hookworm hosts used an infrared sauna regularly for over 15 years without any adverse effect on their colonies. [593]
    • ✅ Ketosis is a metabolic state in which most of the body's energy supply comes from ketone bodies in the blood. This state is often induced deliberately by fasting or the adoption of a low-carbohydrate diet as a intervention in various medical conditions. One commenter has suggested that ketosis should not be harmful to helminths because, like fungi, they have mitochondria so can metabolise fat and therefore utilise ketones as a food source, unlike bacteria and viruses which require carbohydrates to survive. [594] For more on keptogenic diets, see here[595].
    • ❓ Rife machines. These devices are claimed to be capable of killing or "devitalizing" worms when set to 2,400 Hz. Therefore, assuming that they are able to do what is claimed (and this is a contentious issue) it would seem sensible to avoid this particular frequency if using these machines.
    • ✅ Spermidine. When fed to worms, this simple polyamine (found in large quantities in human sperm and grapefruit) significantly prolonged their lifespan. [596]
    • ✅ Steam. Saunas, hot tubs and hot baths do not harm helminths because the body's core temperature remains relatively constant while the skin sweats.
    • ✅ Wim Hof breathing techniques. Someone who hosts hookworms and has done these exercises on and off for about a year has reported having no issues as a result of combining the two treatments. [597]
    • ❓ Zeolite Zeolites are microporous, aluminosilicate minerals that are used widely in water purification systems. One hookworm host has reported taking 1 zeolite tablet daily for a week with no adverse affect on her colony. [598]


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