Helminthic therapy in practice
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Contraindications[edit | edit source]
Helminthic therapy is contraindicated for people with certain conditions.
Before starting[edit | edit source]
What if I already have worms?[edit | edit source]
People considering self-treatment with helminths sometimes ask if they need to make sure they don’t already have any worms before introducing therapeutic ones. However, this is unnecessary in the vast majority of cases, as can be seen from the details on the Deworming debunked page. Additionally, the use of "parasite cleanses" is rarely a good idea, for the reasons set out in this article: Why a parasite cleanse can make you worse.
In a study carried out in Argentina, 12 MS patients were found to be hosting a variety of helminths. Three had Hymenolepis nana, 3 Trichuris trichiura, 3 Ascaris lumbricoides, 2 Strongyloides stercolaris, and 1 Enterobius vermicularis. Only one of these species is a mutualistic helminth (Trichuris trichiura), yet no patient developed clinical disease associated with any of the helminths during the 4.6 year period that they were followed by the researchers. And there were only 3 reported relapses in MS in the subjects hosting this wide range of mostly non-mutualistic helminth species in comparison with 56 relapses in those without any helminths. [1]
However, any potentially pathogenic helminths that also have the capability to proliferate within a host may do so if the host were to become immunosuppressed, for example due to chemotherapy or HIV, or as a result of taking a corticosteroid drug such as prednisone. This could result in a helminth such as Strongyloides stercolaris multiplying and causing the pathologies associated with this species, including Strongyloides hyperinfection syndrome which has a high mortality rate. Therefore, if someone has previously travelled to an area of the world where pathogenic helminths are endemic, they may wish to take a parasite test before commencing helminthic therapy. This would allow them to avoid the possibility that any future immunosuppression might cause the proliferation of a species that would require termination, causing the collateral loss of any therapeutic helminths that were also being hosted at that time.
The only reliable test for this purpose is a PCR (polymerase chain reaction) analysis that checks for helminth DNA, and this can be ordered internationally online from Diagnostic Solutions in Atlanta, Georgia, US. The clinician ordering this test should ask specifically for the helminth test.
What if I have worm phobia?[edit | edit source]
None of the species used in helminthic therapy is visible to the naked eye as a "worm". All four species are supplied by the helminth providers in a vial or small bottle of clear liquid, the contents of three of which are taken orally and one applied to the skin on a bandage/dressing. If, in spite of not having to look at an actual "worm", you are uncomfortable about even the idea of giving a home to an organism that is classifiend as a "helminth", then there are still effective solutions, as you will discover on the following page. Overcoming worm phobia.
What if I need to continue taking medication?[edit | edit source]
Most medications, except anthelmintic drugs, are compatible with helminthic therapy. For more detail, see: Combining helminthic therapy with drug treatments.
Getting started[edit | edit source]
This quick start guide will ensure that the prospective helminth host has covered all bases before commencing treatment.
Obtaining helminths[edit | edit source]
Newcomers to helminthic therapy will often ask in the support group for personal recommendations about the best place to buy helminths, but purchasing worms for therapy needs to be approached on an individual basis.
There are four different species of therapeutic helminth available with two different methods of application, widely differing lifespans and somewhat different effects. None of the companies who supply therapeutic helminths sell all the available species, ship to all global destinations, or accept all payment options. And, while most sell individual doses, with discounts for purchasing multiple doses at one time, a few offer long-term contracts. Therefore, details from all of the following three pages will need to be considered in conjunction in order to make the best decisions about which organism(s) will meet each user’s unique needs and circumstances, and where to purchase them.
Some adventurous would-be hookworm hosts may consider traveling to an area where these worms are endemic, in the hope of acquiring their larvae at zero cost in the same way that the locals do - accidentally, while walking barefoot in open-air latrines. This is a not a good idea, however, for a number of reasons, as is explained here by the only Westerner known to have done this.
DIY helminth incubation[edit | edit source]
Three of the four species of helminth that are used in therapy are suitable for DIY incubation at home. See Helminth incubation. However, if you intend to incubate hookworms, it is recommended that you obtain your starter dose from an established provider because this will obviate the risk of acquiring a different and possibly harmful species of worm, or some other unwanted infection, from another self-treater. See Hookworm incubation issues for more about these risks.
Important considerations[edit | edit source]
Self-treatment with helminths is very individual so, even with guidance, it can take a while to establish the ideal dosing regimen.
Helminthic therapy is typically very slow to deliver benefits when compared with drugs. For the majority who do respond, significant and consistent improvements do not usually materialise until at least 3 months after the first inoculation, with most people only seeing improvement in their condition between 3 and 5 months. Some may only start to improve between 6 and 12 months and a few may even have to wait for as long as 18-24 months.
Once improvements do begin to materialise, some people can experience a sudden and dramatic reduction in symptoms, while others may respond more gradually over time, possibly over three years, or even longer.
One self treater with systemic scleroderma tracked the level of inflammation in her muscles over more than a decade using creatine kinase tests. These show that, after remaining quite high during the 8 years before she began helminthic therapy, her inflammation then quickly dropped to, and remained in, the normal range throughout her first four years with helminths. [4]
Anohther self-treater used fecal calprotectin tests over six years to track the response of her colonic Crohn’s disease to helminthic therapy, and saw her calprotectin levels fall gradually during the whole of this period, as shown in the graph here.
Improvements during the first 2 years are not always continuous because there can be periods of exacerbation during which symptoms may worsen again, albeit temporarily. And approximately 25% of those who try helminthic therapy do not respond at all.
Helminthic therapy is also not a one-size-fits-all solution, nor a one dose fix. Dosing needs to be tailored to the unique needs of each individual, and continued indefinitely in the vast majority of cases.
It is not yet possible to predict exactly who is likely to benefit from helminthic therapy, but statistics compiled from responses to a survey carried out by one provider of NA showed that 70-80% of those who self-treated with this species experienced an improvement in their health. The report of a survey conducted by researchers at Duke University showed that treatment with HDC was effective in more than 90% of cases, although this apparently higher efficacy of HDC in comparison with NA is likely to be at least partly due to the fact that users of HDC tend to be relatively less ill than those who use other therapeutic helminths.
Helminthic therapy is not always a complete solution on its own, and some self-treaters may need to combine this therapy with lifestyle changes, dietary modification [5] and other treatments, either complementary or pharmaceutical. For example, one self-treater has said:
There are many examples of both successful and unsuccessful outcomes in the Helminthic therapy personal stories collection, which presents thumbnails and links to more than 1,000 accounts by people who have used helminthic therapy to treat over 170 different medical conditions.
There are very few doctors who understand helminthic therapy, let alone have any practical experience with it. A few medics are using HDC in some client groups, especially children with autism (video) and a few doctors may recommend that patients with various autoimmune conditions try TSO. There is also a small but growing number of doctors, especially naturopathic practitioners, who are recommending the use of NA and a few doctors have become sufficiently knowledgeable to be able to advise self-treaters. (See Helminthic therapy practitioners.)
The helminth providers are another valuable source of information and guidance, although no one company sells or has experience with all four helminth species, so they are unlikely to be able to match the objectivity or breadth of information found in this wiki, which offers a balanced assessment of all 4 available helminth species based on the findings of science and the first-hand experience of self-treaters. It is therefore recommended that, before proceeding with this therapy, each would-be helminth self-treater should make full use of this site and familiarise themselves with as much of its contents as possible.
The role of doctors[edit | edit source]
At the present time, helminthic therapy is not approved as a medical treatment anywhere outside Thailand, so mainstream doctors - as opposed to naturopathic doctors (NDs) - face the possibility of losing their medical licence if they become involved In its use. Fortunately, helminthic therapy does not need to be doctor-led because, in practice, it is little different from taking a probiotic supplement, which most people do without involving a doctor.
One of the purposes of this wiki is to provide everything that the helminth self-treater needs in order to use this therapy safely, but it is essential that would-be self-treaters familiarise themselves fully with all the relevant sections of the site before commencing their treatment.
While a doctor's involvement is not essential, it can be helpful to have medical support available during the early stages of helminthic therapy. For example, a doctor will be able to prescribe an immunosuppressant drug to ease helminth side effects if these were to become troublesome, or to prescribe an anthelmintic drug if termination of a worm colony became necessary. But exactly how much to involve a physician is a matter for each self-treater to decide for themselves, based on their knowledge of their own practitioner.
Most doctors are dismissive of helminthic therapy, some are even hostile to its use, and many intensely dislike patients taking matters into their own hands to try what the doctor will likely consider an "experimental" treatment. Fortunately, all that is required from a doctor is that, while the patient is using helminthic therapy, they continue to provide the routine medical care that they would normally provide.
If a helminthic therapy self-treater decides to tell their doctor what they are doing, the language used can be important because, if a doctor thinks that their permission, approval or cooperation is being sought, they may feel they have no choice but to refuse to become involved in any way. To avoid placing a doctor in a difficult position, they can simply be informed by the patient of their intention to pursue the therapy. This lets the doctor off the hook and gives them the option of ending the relationship if they feel uncomfortable about it.
Doctors should certainly not disparage this therapy nor try to dissuade their patients from using it, especially if they are not fully conversant with the therapy. Any physician who does arbitrarily discourage self-treatment with helminths, in disregard of all the available research and anecdotal evidence would clearly be violating the Hippocratic principle of primum non nocere (first, do no harm) and, in acting in this way, would arguably be committing medical abuse.
If a doctor is open to learning about helminthic therapy, they can be given a link to, or a copy of, the concise summary of information on this wiki page: Helminthic therapy information for doctors.
One patient who shared a few selected scientific papers with her doctor and explained what she’d learned about the therapy reported that, after glancing through the literature, the doctor responded as follows.
Here are comments by other patients who have found their doctors to be supportive of their decision to try helminthic therapy.
But some doctors are completely closed to even learning about this therapy. When an extensively published and award-winning toxicologist presented the head of adult allergy and asthma at his local university with papers about helminthic therapy, she refused to consider them and promptly fired him as a patient. (Link expired)
Another self-treater whose doctor was not supportive found it necessary to locate a new one when he needed a prescription for prednisone to help ease the initial side effects after inoculating with too many hookworms. He did this by identifying all the most alternative and “hippie-looking” doctors in his area and emailing them. While most of them declined to help him, two agreed, and the one he selected carried out before-and-after blood tests and was willing to prescribe whatever he needed.
One self-treater takes a very proactive approach when introducing the subject with a doctor.
For further help with talking to a doctor about helminthic therapy, see the following resources.
- How to talk to your doctor about helminthic therapy (Scroll down the page to locate the article.)
- Helminthic Therapy Reading packet. (A list of scientific papers that are suitable to be given to a doctor.)
Doctors as helminthic therapists[edit | edit source]
Some naturopathic doctors (NDs), may recommend helminthic therapy and be willing to become involved in its use, and a few may act as an intermediary in the supply of helminths to their patients. However, even some NDs can be poorly informed about helminthic therapy, and those whose understanding of it is limited can sometimes give their patients incorrect advice. For example, one patient was told by an ND that worms won’t work in someone who has SIBO, which is not the case. See Helminthic therapy and small intestinal bacterial overgrowth (SIBO).
Doctors who do offer helminthic therapy to their patients often do not treat a sufficiently large number of individuals to have encountered some of the outliers with conditions that require a modified approach to helminth dosing, especially the extremely hypersensitive and those who are helminth permissive, i.e., their immune systems allow much longer helminth persistence. Some NDs may also favour the use of a fixed dosing protocol which they have personally determined as being best for most patients, rather than employing an individualised dose-finding approach in each case, starting with a very small number of worms as recommended in this wiki.
This latter factor can be a particular issue in the case of therapy with the hookworm, NA. The range of physician-determined dosing protocols for introducing NA varies widely, from the addition of a single larva every week or fortnight, to starting with a single dose of between 25 and 35 larvae. If a patient encounters adverse effects as a result of dosing that proves to be too much for them, an overseeing physician will obviously be able to prescribe immune suppressant drugs and/or anthelmintics, but this eventuality is arguably best avoided in the first place by following a very gentle introductory protocol that establishes the unique dosing needs of each individual. See Hookworm dosing and response.
If a doctor offers to supply helminths, their prices should be checked against those of the online helminth providers, who will likely be considerably cheaper. Some doctors have claimed that the worms they supply are more gentle, “stronger”, more effective, or even safer, than those available online, but none of these claims is true. See Doctors as providers. The only possible difference between the worms available from doctors and online helminth providers is seen in the "fresh" and "commercially prepared" versions of HDC, and, in this case, correct dosing with commercially prepared HDC fully compensates for their slightly reduced effect in comparison with fresh HDC. See Dosing with HDC.
For a list of doctors who are experienced in the use of helminthic therapy and who offer remote consultations via telephone and Skype, see the following page.
For information about combining helminthic therapy with drug treatments, see this separate page.
Documenting one's helminthic therapy experience[edit | edit source]
Unlike pharmaceutical treatments, helminthic therapy is a journey that unfolds over a number of months and, to a lesser extent, over the first two or three years. Recalling the details of one’s experience can be important for informing choices about dosing, which needs to be optimised in the early stages of treatment and may require further adjustment over time. Since memory about these details can fade quickly, it’s important to record the size and dates of doses, along with details of any physical and/or symptomatic changes that occur along the way.
Some people have found a log app useful for this, possibly combined with a disease activity index to take periodic snapshots of progress during treatment, for example with Crohn's disease, [11] Ulcerative Colitis, [12] Rheumatoid Arthritis, [13] Ankylosing Spondylitis [14] or Lupus (SLE). [15]