Helminthic therapy and inflammatory bowel disease (IBD)

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    The anecdotal evidence

    Many thousands of people are using helminthic therapy to treat Crohn’s disease and colitis, and the following quotes are indicative of the results being achieved.

    I have been keeping Crohn's Disease and CD arthritis in remission using only helminths for the last 10 years. HT (using TTO, TSO and NA) is the best treatment I've tried and has no negative side effects. As long as I keep my colony large enough and healthy. I was diagnosed at age 12 and I'm 52 now. It has been a long struggle to find something that works. Helminths have been a life saver for me.
    This treatment has put my UC in complete remission and I am prescription free. I was able to get completely off prednisone, 6-MP, and asocol. I am medication free and symptom free. I feel and function completely normally! I would not have graduated, or have a career, or a normal life in any way had it not been for this therapy. I can't say enough good things about it!!!

    The following graphic shows the colon of a patient with ulcerative colitis before and after treatment with TSO. (Read the whole paper here.)

    TSO for ulcerative colitis.png

    See the following links for more visual evidence of the effects of helminths on IBD.

    The following detailed personal stories were written by people using helminths to treat Crohn’s disease or ulcerative colitis.

    Here are collections of brief reports written by people using helminths to treat IBD.

    Research findings

    Treatment of moderate to severe IBD involves the use of immune modulators and/or biologics, which have several toxicities and side effects, such as predisposition to infections, cancer, and demyelinating diseases in addition to others. Helminths or helminth products are attractive therapeutic avenues given their safety profile.
    The authors conclude that most of the currently available IBD therapies expose patients to substantial risk, whereas helminths will likely prove to be safe in therapeutic applications and that the administration of helminhs such as T. suis offers an approach to treating IBD with little risk of serious complications.
    The aim of this systematic review was to investigate whether there is evidence to support the use of helminth therapy for the management of Crohn's disease and ulcerative colitis… all nine studies concluded helminth therapy was safe and tolerable, and therefore there is currently no evidence against further exploration of this treatment option.
    While certain enteric pathogens are associated with an increased risk of IBD, others are potentially protective. For example, helminth colonisation and Helicobacter pylori infections were associated with a consistently reduced risk of IBD.
    A lack of Helminths is associated with an increased incidence of IBD.
    Helminth exposure may prevent IBD in children.
    Colonisation by the human whipworm, Trichuris trichiura, showed several indicators of mucosal and systemic immune modulation.
    Reversal of IBD in mice colonised by a helminth was mediated by an increase in beneficial Clostridiales, which, in turn, reduced the number of disease-causing Bacteroides.
    This survey of helminthic therapy self-treaters found that all four domesticated helminth species (NA, TTO, TSO and HDC) were being used to treat IBD, with a reported efficacy rate averaging in excess of 80% for Crohn’s and over 90% for colitis.
    The risk from therapeutic helminth exposure is modest compared with the dangers of modern pharmaceutical therapies for IBD, which can promote and worsen pathogenic infections.
    An individual who self-infected with Trichuris trichiura ova (TTO) experienced almost complete remission of his colitis symptoms.
    Infection with Hymenolepis diminuta cysticercoids (HDC) was found to be superior to daily corticosteroids in the prevention of colitis in mice, and did not result in additional side effects.
    Failure to acquire helminths in early life negatively affects immune development, leading to immunological diseases such as IBD later in life.
    • 2008. This year saw the start of a large, decade-long, research programme involving twelve trials set up to investigate the effects of TSO in several diseases, including IBD. The entire programme was doomed by fundamental failures in study design, and all but three of the trials were discontinued prematurely, ostensibly due to a lack of beneficial effect. Unfortunately, the large number of trials involved, and the lack of understanding of the design flaws by the vast majority of commentators, including members of the medical profession, has led to the widespread, albeit incorrect, belief that TSO is ineffective as a therapy. For more detail about this flawed research programme, see The history of helminthic therapy: 2008.
    43.3% of patients with active ulcerative colitis who were given TSO showed improvement, in comparison with only 16.7% of those receiving a placebo.
    79% of patients with Crohn’s disease who were given Trichuris suis ova (TSO) responded with a significant reduction in symptoms.
    The safety and efficacy of treatment with TSO was demonstrated in patients with Crohn’s disease and ulcerative colitis.
    Researchers at Iowa university reported that six patients with acute, chronic IBD were successfully treated with TSO after previously failing pharmaceutical therapies. When they relapsed after the worms died, they were said to be "begging to be re-treated”.

    See also.

    For more research papers on helminthic therapy and IBD, search the following page for the terms, “Crohn” or "colitis", “bowel” and “IBD”.

    Limitations of helminthic therapy in treating IBD

    Previous structural damage cannot be reversed

    While the disease process can be arrested by helminthic therapy, any structural damage, such as scarring and strictures that have already formed as a result of disease, cannot be undone by hosting helminths.

    Duration and severity of illness, and age of patient, can restrict benefits

    A favourable outcome is more likely in those who are young, have a less severe form of the disease, and have had their illness for a shorter period of time. For example, among self-treaters using NA who are "very sick" with IBD, the treatment is only successful in about 40% of cases of ulcerative colitis and 65% of Crohn’s disease patients. [1]

    Intestinal fistulae and abscesses are likely to require conventional treatment

    Helminths subdue inflammation over time by gradually calming the immune response, but this effect is too subtle to deal with acute inflammation or its consequences. Therefore helminths are unlikely to be able to treat fistulae or abscesses without the use of surgery and/or medication. (The gastric pentadecapeptide, BPC 157 (Bepecin), may also be worth consideration. [2] [3] [4]) Once these conditions have been brought under control, however, the immunomodulation provided by helminths may prevent the development of further abscesses or fistulae.

    One helminth self-treater has reported that, after having a fistula surgically corrected prior to starting helminthic therapy, she was mostly in remission for the subsequent 7 years, topping up her helminth colony whenever her symptoms began to return. [5]

    It is not ideal to start helminthic therapy while IBD is flaring

    The introduction of helminths triggers a response from the host's immune system, and this can increase intestinal inflammation during the first 100 days of treatment, peaking at around 50 days. This inflammatory response, which is largely dose-dependent, may temporarily worsen an existing flare. It is therefore best to commence helminthic therapy while IBD is quiescent, or to take an immunosuppressant drug alongside the therapy until any additional inflammation resolves. If this is not possible, advice should be sought from a helminthic therapy-literate medical practitioner and/or an experienced helminth provider.

    Helminthic therapy may take up to two years to deliver consistent results

    While consistent results are typically seen in a matter of months, they can take much longer to materialise in a few cases, especially when using the human helminths, NA and TTO. The pig whipworm, TSO, produces results more quickly. For further details about the response times of each species, see the following links.

    It will be obvious from the above that it is not a good idea to "save" helminthic therapy as a treatment of last resort. Commencing helminthic therapy as soon as possible will increase the chance of success, and many people have expressed considerable regret that they delayed getting started with this therapy.

    Helminthic therapy is compatible with conventional IBD therapies

    Helminthic therapy is fully compatible with the use of immunosuppressive drugs. See the following page section for more details.

    Someone with ulcerative colitis who saved his colon and eventually got off all systemic high-risk immunosuppressive medications by hosting worms, does continue to take a high dose of Balsalazide in addition to maintaining his helminth colony.

    This cheap, oral 5ASA medicine costs me $5 a month with no side effects and works locally without messing with my immune system. I actually recommend most of the people who message me really try different 5ASAs before HT as they may be lucky and not need HT. I will probably take Balsalazide for the rest of my life along with HT. I feel extremely blessed that I still have my colon after 20 years and don't need to take steroids, biologics, or other systemic immunosuppressive medications anymore. [6]

    The absence of regulatory approval belies the confidence of some researchers and clinicians

    No mainstream medical doctor is able to offer or officially condone helminthic therapy, or support its use, because it has not yet been approved for clinical use by any national regulatory body outside Thailand. [7] And regulatory approval is unlikely to be forthcoming in other countries in the foreseeable future because the fact that living helminths cannot be patented makes it all but impossible to obtain funding for the type of trials demanded by regulators.

    There have also been significant failures in the design of many of the clinical trials that been conducted previously using living helminths, to the extent that the conclusions from the majority of the most recent trials cannot be relied upon, as is explained in the following section of this wiki.

    Most gastroenterologists remain unaware of this treatment, and those who lack an appreciation of the issues with much of the research may dismiss it as unproven, or even claim it to be potentially harmful. However, this position by medics does not prevent patients from using the therapy, which is essentially not a medical treatment. It is a natural replacement therapy used to correct a helminth deficiency, and, as such, it is already available for use at home by patients employing one or more safe "probiotic" helminths.

    Although self-treatment with helminths cannot be recommended by medical professionals due to a lack of blinded, placebo controlled trials, neither should it be discouraged since the available evidence suggests that it is beneficial in most cases when practiced by knowledgeable individuals. [8]

    There are many doctors who are already using helminthic therapy as a self-treatment to address their own health issues (e.g., this pathologist) and those of their families, and scientists who have thoroughly investigated helminthic therapy have no reservations about treating themselves with worms.

    In developed countries, where we are well nourished, worms are potentially good... If I had Crohn’s disease, ulcerative colitis or multiple sclerosis, I would infect myself without hesitation. (Prof Alex Loukas, Australian Institute of Tropical Health & Medicine) [9]

    Selecting a suitable helminth for IBD

    Many self-treaters have found that TSO and NA are both very effective against Crohn’s disease, and that colitis responds well to either TSO or TTO. Some colitis patients have reported success using NA, either alone, or in combination with TTO or TSO, and a few have had good results treating both Crohn's and colitis with HDC. For more details about helminth selection, see the following page.

    Support for IBD patients using helminthic therapy

    To talk with people who are using helminths to treat Crohn's disease or ulcerative colitis, join the following support group.

    To book an educational consultation with either a medical professional, or a specialist health coach, who is experienced in the use of helminthic therapy, see the following list.

    Further reading

    Given that helminthic therapy can take a while to begin producing benefits (up to 2 years in the case of NA [10]) it can help to have alternative treatment options to turn to while waiting for the worms to begin to work. The following two documents contain a wealth of mostly science-based, natural alternatives.

    See also