Helminthic therapy and fecal microbiota transplant (FMT)

HT and FMT can be complementary

A healthy microbiome and a few probiotic helminths can complement each other, so the combination of FMT with helminthic therapy may be more effective than either one used alone.

Our findings show that murine intestinal helminth infection not only alters the intestinal bacterial communities but that intestinal bacteria contribute to the ability of helminth infection to attenuate allergic airway inflammation. [1]

Reports from those who have used both therapies confirm that helminthic therapy (HT) and faecal microbiota transplant (FMT) are a very effective combination.

I have Hashimoto's and some related symptoms: food intolerances, migraines, fatigue, poor endurance. Many of my symptoms are under control thanks to diet and FMT. Using those modes of treatment my anti thyroid antibodies decreased to about 80-100, but whatever I did I could not decrease them further. Well, now, 4-5 months into TSO (and I’m probably taking too small dose of 700 ova) my antibodies test results came back at 58. It is not a huge improvement, but it is an improvement and they would not budge any other way, so I am very happy. I also feel better and stronger - subjectively. [2]

It may be best to start HT and FMT separately

If intending to do both therapies, it can help to start them separately so that it will be easier to determine which is producing any benefits or side effects that appear.

As someone who has done FMTs and just started on worms I suggest doing one thing at a time, at first anyway. This is so you can assess the benefits and side effects of each treatment. If you do both at once and some symptoms improve while you also get side effects you won't be able to tell the cause. [3]

Which to do first: HT or FMT?

A few people recommend starting with FMT.

I did FMT first and I'm glad I did. my NA are part of the solution but could not have fixed my microbiota deficits. [4]

As a first step, I suggest doing one or a few FMTs in order to knock out any pathogenic bacteria you may have in your gut. That may also kick start rebuilding your gut flora. Then try some helminths. Give them several months to settle in and reduce inflammation. Then assess your situation and make an educated guess as to whether more FMTs and/or worms may help further. [5]

While the majority favour doing helminthic therapy first.

Helminths reduce inflammation and secrete compounds that favour beneficial bacteria. Exactly what you need (besides a good diet) for the new bacteria to stick [6]

I think doing the helminths first would increase the chances of having a successful FMT. I did a series of FMTs a few years ago and had very little change in my condition, and I think I was too inflamed for it to take. [7]

I had FMT for IBS/food intolerances 1½ years ago and I have to say it was no golden bullet… I have just started Helminthic therapy but looking back I would do the Helminthic therapy first as it is cheaper and depending on the root causes it may also be more effective… [8]

I would definitely recommend commencing HT before FMT. I did FMT in August and inoculated with 5NA in September. I have been in a notable flare (Hashimoto's and Sjogren’s) since undergoing FMT. So far, I'm tolerating the NA well… (Link expired)

My argument for doing worms before FMT is that the side effects of the worms (diarrhea) might erase the newly acquired flora. [9]

I would second the recommendation to try HT first. (Link expired)

I did FMT (5 months ago) -- just prior to HT -- and I'm still flaring from the treatment... I wish I had commenced HT first. [10]

I tried FMT - 2 weeks of Monday-Friday treatment at the Taymount Clinic in England, (but) I wish I would have given helminths a try before FMT.

While FMT immediately resolved the IBS complaints I had, something in that new bacteria was not a great fit for my body. Within a week, my thyroid became underactive and I had to increase my thyroid dose. Two months later I had to increase the thyroid medication dose again. When my thyroid is underactive, I can gain 10 pounds overnight. Because I have lipidema (a genetic disorder that causes fat cells to grow similar to cancer), once I gain weight, it is nearly impossible to lose it.

A few years after getting FMT the benefits were waning so I started with TSO and within weeks had the perfect stool (as judged by Bristol stool chart) plus the violent allergic reaction I had developed to cottonwood trees literally disappeared. Now I can enjoy those little fluffs of cotton dropping off the trees in springtime. [11]

And the following comment is from a paediatrician.

… if somebody came in to me with recalcitrant Clostridium and nothing had worked… I would do FMT first. But if a child’s coming in with autoimmune disease or autism and that’s what they’re considering, I would do (HT) hands down for months before I would even consider FMT. [12]

FMTs from a helminth-hosting donor may have an edge

It is possible that a fecal transplant from a healthy donor who is hosting helminths might have additional therapeutic potential as a result of the helminth components it will contain.

The immuno-modulatory capacity of helminth infection could be transferred through fecal transplantation and correlated with an increased availability of microbial-derived short chain fatty acids (SCFAs). [13]

The comparative effectiveness of HT and FMT

Someone who has tried both treatments is clear about which has given her the best results.

I tried FMT 15 years ago and it did nothing for me. HT has not only reduced my food intolerances and insomnia, it has significantly reduced my allergies to grasses, cats and whatever else was causing my hay fever and itchy throat. [14]

The comparative safety of HT and FMT

While helminthic therapy is very safe, there have been numerous reports online of adverse effects being experienced following FMTs, including some serious ones such as untreatable depression, autoimmune symptoms, weight gain and hair loss, [15] and even a number of hospitalisations and at least one death. [16] Unfortunately, there appears to be a culture within the FMT sphere of denying adverse effects, and one Facebook FMT group that drew attention to the reality of the risks was closed down. [17]

FMT side effects and risks

Several members of the Helminthic Therapy Support group on Facebook who have investigated this issue have consequently said that they would only consider trying FMT themselves as a last resort.

I am on the fmt page and I think it seems to do well for some people but when it goes wrong it can be pretty dire. Idk, it's seems way more risky than helminthic therapy. [18]

I think at this point too much is unknown about it (FMT). It can be lifesaving for c diff patients, but it would be a last resort for me. [19]

Further information

A good overview of the history and practice of FMT

Fecal microbiota transplants: Past, present and future

FMT websites

FMT notes by Maximilian Kohler
The Power of Poop This is now only available as an archive of the website as it existed in 2015, so much of its information is out of date, but it does still feature many interesting success stories and a useful set of DIY instructions.

FMT support groups

Fecal Microbiota Transplantation (FMT)

Bacteriotherapy An active and informative Facebook group.

FMT & Bacteriotherapy Discussion This Facebook group was created by the founder of the Power of Poop website (see FMT websites, immediately above).