Hook me up! Treating autoimmune disease with hookworms
A report on the successful use of hookworms to treat guttate psoriasis, and a review of the helminthic therapy literature.
I had to write this, although I would rather not.
But the knowledge that it could potentially help so many people in the same way that it has done for me weighs heavily on my mind. It creates a moral obligation to disseminate this information and allow people the option of acting on information that has taken me years of searching to discover…
What if I told you that you are missing a few strands of DNA. DNA that if added back to your natural biome could affect all kinds of changes to your physiology.
DNA that has been present for hundreds of thousands of years. Until recently, when we took steps to eradicate it.
As always, action and consequence are inseparable.
Background
Helminthic therapy, or self infection with one of a select few species of parasitic worms, is a controversial topic. With good reason. Hookworms are a leading cause of disease in the developing world with around 750 million people suffering from infection, which can cause anaemia, growth retardation and malnutrition in heavily infested populations. Hookworms can even be lethal, with hookworm related death standing at an estimated 60,000 people per year.[1][2]
In first world nations, cleanliness, sanitation and clothing measures have eradicated hookworm infections by breaking their life cycle.[3][4] This may seem like a good thing at a casual glance. The economic impact of hookworms is huge for some countries. For example, productivity losses due to hookworm in South Asia have been estimated at a value of approximately 5 billion dollars annually.[1] At first glance, exterminating these parasites seems wholly sensible.
There is a caveat, however, to throwing nature out of balance by Man’s crude intervention. Firstly, by vastly overpopulating areas and creating the perfect conditions for huge hookworm burdens we generate conditions where they can continually infect us. Secondly, by removing hookworms completely, we induce conditions unnaturally sterile. Our bodies, finely tuned through eons of evolution to respond to the challenge of parasite infection, respond erratically.
Westernised nations have witnessed a dramatic rise in the incidence of chronic inflammatory and autoimmune diseases, a rise that is concurrent with hookworm eradication. Researchers soon realised that many autoimmune diseases are largely absent in Third World populations. This discovery gave rise to the 'Hygiene Hypothesis'.
The Hygiene Hypothesis theorises that the absence of various micro-organisms in Western society causes dysfunction in immunoregulation.[5][6] We see this manifest itself in diseases such as MS, Crohns disease, asthma, and rheumatoid arthritis. This theory can be traced back to the 1870s when it was noted that aristocrats and city dwellers were more likely to get hay fever than farmers.
This idea was further developed into the 'Old Friends Hypothesis'.
Whilst it would be rash to state that the increase in autoimmune diseases seen in our society is solely due to helminth eradication, it is certain that the underlying cause in genetically susceptible individuals is environmental. One of these environmental factors is the removal of helminths, or ‘old friends’.[7]
In Rooks’ words:
In effect, organisms like helminths have been present in the human environment since the evolution of our species. Our immune systems have been titrated to their presence. Genes have been selected for in the human species to help to manage the burden of these organisms, genes which predispose individuals to autoimmune disease once the helminths have been removed.
Necator americanus
At this point it seems pertinent to introduce one of these ‘Old Friends’. Enter the hookworm, Necator americanus
(NA, Necator = Killer, americanus = American. Note: Caucasians have less tolerance to NA than other ethnicities, hence its name!).
There are other species suitable for helminthic therapy, but this creature is so adapted to living with humans it is considered by many to be a ‘symbiont’ rather than a parasite. In sensible doses, it appears to offer several benefits to its host (the human) and, in return, it gets the opportunity to proliferate and ensure the survival of its own species.
The life cycle of Necator americanus does not make pretty reading. Making a living as a parasite, even a relatively symbiotic one, is not for the squeamish.
NA start life as eggs passed out in faeces of an infected individual. In the right conditions (28-32 degrees Celsius and humid), they hatch within 48 hours into first stage larvae and moult again into third stage larvae by 5-7 days. They then migrate to the soil surface or cluster in moisture droplets on ground flora. Should they get into direct contact with a human, often through contact with bare feet on infected soil, they penetrate the skin into blood vessels and are swept up by the circulating blood to make a quite remarkable journey.
The larvae travel around the body in the blood, through the heart, and, when they sense they are passing through the lungs, they penetrate into the alveoli, where, powered by their fat stores, they crawl up to the pharynx and are swallowed down into the digestive tract. Once at the jejunum of the intestines, some 3-7 days after first infection, they begin to suck blood from their host. On average, a mature NA will harvest approximately 0.03ml of blood per day from a host. By 4-6 weeks, and at approximately 1cm long, they reach maturity and females begin egg production, at which point the cycle is complete. (See Hookworm lifecycle.)
Importantly for therapeutic uses, NA cannot proliferate without eggs exiting the body and maturing in the right conditions. Hence it is easy to see how simple sanitation breaks their life cycle. Furthermore, I cannot find any reference of this species migrating to the wrong tissue. They exclusively parasitise humans, and are highly efficient in the business of getting into your guts. As such, their dose is controllable, a colony can be effectively eradicated with simple medication, and, in sensible numbers, they are well tolerated. At a dose of 25-30 NA, once established, they are largely asymptomatic. Do note however, at doses of 100-500 worms, damage to the intestine is considerable, while doses of 1000 worms may be lethal.[8]
This is all very interesting, and I am sure for some, a rather unpleasant thought. But surely no-one in their right mind is going to infect themselves with these creatures to see if the scientific hunch about ‘Old Friends’ is correct!?
Well, people do, in their thousands.[9] It is just not a topic that is often broached over the canapes at dinner parties.
Starting with a handful of forward thinking, pioneering mavericks, with special mention of Prof Pritchard of Nottingham University, who allegedly infected himself with 50 NA larvae in order to get ethical approval to start human trials,[10] all the way up to companies that offer affordable NA larvae for sale online. (See Helminth providers.) There are patients desperate for an efficacious treatment when modern medicine has failed them, and when you are faced with a problem you cannot solve with conventional techniques, you need to disregard convention.
Which is where my own story began.
My psoriasis worsens
Suddenly, at age 30, the very mild and intermittent psoriasis that had occasionally presented itself on my skin, literally exploded. It coincided with a new and very stressful job, pressures at home, less chance to exercise and most definitely less sleep.
The visible skin lesions were the least of my problems. A once bullishly confident mentality spiralled into anxiety and self-doubt, my iron gut developed intolerances for pretty much everything I ate, and I awoke most mornings to the feeling of mild flu-like symptoms. The gluten in a pint of lager or a sandwich would set my skin burning for hours afterwards, and without going into too much detail, my bowels decided to wring themselves out every couple of hours.
Finally, I dragged my carcass, some 20lbs lighter than my usual fighting weight, to the doctor. A ‘specialist’ I might add in dermatology.
“Love to cure this” he scoffed, after a 10 minute monologue on the epidemiology of guttate psoriasis.
“But I can’t. There is nothing you can do but keep using the steroids.”
Reaching back into my science-based background, I suggested that, since I had spent 30 years pretty much free of any problems, there MUST be an epigenetic mechanism for my current predicament.
This was bordering on dissent, and with a scowl of his ridiculously bushy eyebrows, I was dismissed from his office.
Finally, after paying to see a real dermatologist, I was referred to a local dermatology consultant.
By now I had come up with a protocol of diet, fasting, various supplements, UVB exposure, topical steroid use, heat therapy and cold thermogenesis that reduced my symptoms maybe by 50%. At least I wasn’t bleeding into the bed covers overnight and I had control over my mindset once again.
I was offered Methotrexate, and I thought I had finally exacted some semblance of control over my aberrant immune system, but not so. We had to keep increasing the dose to maintain the effect. Realising this strategy was unsustainable, and suffering the side effects of systemic drug use, I redoubled my efforts to find another solution.
Then, one day, a chance comment from a medical doctor about some research being conducted in Nottingham set my mind alight. They were conducting a trial on Multiple Sclerosis patients, using hookworms to attempt to induce remission.
My hookworm therapy experiment
Hookworms make intuitive sense for anyone who views the world through an evolutionary lens. Although the mechanisms through which helminths can regulate our immune systems are still being teased apart[11][12] it didn’t matter to me. I just needed to be sure they might alleviate my symptoms, and that they were safe.
A few short weeks and a lot of reading later, I sat at home, looking, with serious trepidation, at a small vial filled with clear liquid.
Inside it, were 25 stage L3 NA larvae, purchased online with laboratory assurance that they were as sterile as a multicellular organism that comes from faeces can be. (NB. A dose of 25 NA larvae is no longer considered an appropriate introduction to therapy with this species. For current guidance on hookworm dosing, see Hookworm dosing and response.)
Now I am not by nature someone who puts off what needs to be done. But I won’t lie when I say it took a few minutes of serious contemplation before I pipetted the innocent looking fluid onto the supplied dressing, and pressed it onto the skin of my inner arm.
Would this work? Did the larvae survive transit? Would they find their way onto my skin?
I needn’t have worried. Less than two minutes after application, it felt like dozens of hot needles were boring into my skin. This was very real, and now there was no going back. They were inside me.
My body went fucking mental!
I didn’t sleep that night such was the itching on my arm, and I got a low grade fever the next day that lasted 48 hours.
Exactly 5 days post inoculation, I awoke in the middle of the night thinking someone was choking me. My throat was burning, causing my breath to rasp in my chest. As I sat in the bathroom gasping for breath, I knew exactly what was happening. The larvae had made it to my throat and were about to finish their migration down into my intestines.
Ten days after inoculation, I awoke once again in the early hours of the morning to terrible stomach ache. My regular regimen of intermittent fasting was out, the only remedy for this was a large breakfast, which, for reasons unbeknown to me, helped ease the symptoms. My skin, likely because I had stopped the Methotrexate, worsened.
Bereft that I might have to drag myself back to the Dermatologist and actually ask her for worming tablets, I toughed it out.
Then, at 3 months, I realised I hadn’t had gut ache for a few days.
By 6 months, my skin started to heal.
By 9 months I realised I could eat and drink a ‘normal’ diet with only minimal flare ups of my skin symptoms.
The pictures taken at 10 months post inoculation make clear the extent of remission I experienced from a single dose of these remarkable creatures. It is now time to try adding another dose and see how I tolerate them and if it will further benefit me.
Coincidence? I don’t think so, my psoriasis had been gradually worsening for around 5 years prior to this.
The wider context
It is useful to put this single experience in the context of the problem facing the medical community.
Over 23.5 Million Americans are afflicted with autoimmune disease, which is also in the top ten causes of death for women younger than 65 years of age.[11] This pattern is repeated throughout other westernised cultures, and incidence of diseases such as Crohn’s and ulcerative colitis continues to surge.
In short, everyone will know of someone battling with an autoimmune disease that is potentially ‘incurable’. Once your immune system learns to attack your own tissues, it never forgets.
It may seem like self-treatment with a known human parasite is a cavalier approach taken by people desperate for a solution to their illness. In actual fact, there is a wealth of evidence that continues to build in favour of using helminths as an efficacious treatment for autoimmune and inflammatory disease, [13][14][15][16][17] plus too many more to list. (See Helminthic therapy research for a collection of the literature.) It is just unfortunate that adequately powered human trials are sparse. Sadly, on the merry-go-round of funding for clinical trials, nobody makes money from a hookworm unless they can patent it. To do that, they would need to synthesise the molecules it produces which modulate the immune system, put a fancy pharmaceutical name on it, and charge a small fortune for its use. In short, turn it into a pill. Why else would the FDA label hookworms a medical device? Yes, if you want to get some NA larvae in the US, you’ll have to order them online from one of the Helminth providers.
Thoughts on helminthic therapy
So how are helminths able to effect such change on our immune systems?
Whilst not completely understood, there seem to be several mechanisms that helminths use to modulate the immune system.
- Improvement of intestinal barrier/mucosal layer.[18][19]
- Beneficial improvement in gut microbiota.[17][20]
- Shift of the immune system response from a Th1 to a Th2 response.[12][21][22]
- Secretion of immune modulating compounds that allow helminths to evade the immune system and reduce inflammation.[23][24]
(As an aside, for anyone interested in ‘leaky gut syndrome’, or its link with autoimmune disorders, this paper by Fasano is a great place to start reading,[25] and also see the leaky gut syndrome page on this website.)
What does the future hold for this form of therapy? It has genuinely changed my life, but not everybody will be willing to infect themselves with a known human parasite.
Furthermore, it is unlikely that the medical community will make helminthic therapy standard practice any time soon. The jump to prescribing hookworm larvae to patients is a huge shift in practice, even if randomised control trials in human populations show definite benefits over standard treatments.
For now, the best option for any interested, prospective patient is to firstly assume ultimate responsibility for their own health.
No matter how proactive and empathetic your physician may be, your health is your responsibility. Only by fully arming yourself with the requisite information needed to provide you with a clear course of action, will you have the empowerment of foresight.
No-one can guide you to take this course of action, nor should they. It is a decision you must make yourself, after deep contemplation of the facts.
Helminthic therapy may help a plethora of health issues, using either the hookworm, Necator americanus, one of two species of whipworm - either the human whipworm, Trichuris trichiura, or the pig whipworm, Trichuris suis, which only persists in the human body for a few weeks - or the small murine tapeworm, Hymenolepis diminuta.
Personally, I would no longer be without these ‘old friends’. And not just for reasons of autoimmunity.
Through the excellent and thought provoking work of PD Mangan published at Rogue Health and Fitness, I have recently been made aware of the role of iron in aging and chronic disease. ‘Ferrotoxic’ disease is briefly surmised as the range of conditions for which body iron burden is a contributing factor, and is increasingly being linked to a host of the usual chronic diseases such as malignancies, endocrine disorders and cardiovascular disease.[26]
A number of striking points came to mind upon reading about the issues of increased iron burden. Firstly, the body has no means of removing excess iron, instead storing it as ferritin.
Why would the body not evolve a mechanism through which to remove excess iron, given how reactive and potentially damaging excess iron can be?
Well, it never had to. There were always parasites gradually removing it through blood loss. Some helminths are well documented to cause anaemia if the parasite burden gets too high[27] and, as we have seen, helminths are consistently prevalent in humans without access to modern sanitation. A situation that was the norm for our ancestors up until a few generations ago. Consider this: each NA harvests around 0.03ml +/- 0.015ml of blood per day from its host. Even a mild NA infection of 100 worms will remove 3-4 mls of blood per day, over a litre of blood per year, causing an iron loss of around 675mg per year.
Is it possible the removal of helminths from our natural biome is leading to a potentially detrimental increase in ‘normal’ iron levels? (Also see Helminthic therapy and nutritional deficiencies.)
Along with many other questions surrounding helminth infection, this is something I would implore researchers to investigate.
For now, it is clear that helminthic therapy offers a cheap and highly effective treatment option for various autoimmune diseases. Furthermore, moderate helminth infection and its anti-inflammatory components may have additional benefits such as in iron homeostasis as mentioned above, and the reduction in conditions like depression and cardiovascular disease.[28][29]
Maybe one day in the future, people will infect themselves, and even their children, with hookworms, in the knowledge that it will help to protect them from a variety of ills.
Such has been the co-evolution between us, I believe this is plausible. The more you examine the relationship, the more it seems to be mutually symbiotic.
For now, people are restricted to sourcing these organisms - this missing DNA - online, with often little or no backing from their medical professionals.
This must change, and medical science must step up to the mark and examine helminthic therapy in the cold light of logic. Not be swayed by misinformation, emotive opinion or profit driven pharma dollars.
I have personally found helminthic therapy to be a startlingly effective treatment for my autoimmune disease. As such, it should be the right of every individual to be able to safely access helminths, and restore their ancestral biome.
References
- ↑ 1.0 1.1 Crompton DWT and Nesheim MC (2002) Nutritional impact of Intestinal Helminthiasis During the Human Life Cycle, Annu. Rev. Nutr. 22:35-59, doi:10.1146/annurev.nutr.22.120501.134539
- ↑ de Silva NR et al (2003) Soil-Transmitted helminth infections: updating the global picture, TRENDS in Prasitology, Vol 19, No.12, 547-551
- ↑ Brooker S et al (2004) Human Hookworm Infection in the 21st Century, Adv Parasitol, 58: 197-288, doi: 10.1016/S0065-308X(04)58004-1
- ↑ Crompton DWT (2000) The Public Health Importance of Hookworm Disease, Parasitology, 121, S39-S50
- ↑ Stiemsma LT et al (2015) The Hygiene Hypothesis: Current Perspectives and Future Therapies, ImmunoTargets and Therapy, 4: 143-157
- ↑ Versini M, et al (2015) Unravelling the Hygiene Hypothesis of Helminthes and Autoimmunity: Origins, Pathophysiology and Clinical Applications, BMC Medicine, 13:81, DOI 10.1186/s12916-015-0306-7
- ↑ Rook GA (2012) Hygiene Hypothesis and Autoimmune Diseases, Clinic Rev Allerg Immunol, 42:5-15
- ↑ Mehlhorn H (2015) Necator Americanus, Encyclopedia of Parasitology, DOI 10.1007/978-3-642-27769-6_2077-2
- ↑ Cheng AM et al (2015) Overcoming Evolutionary Mismatch by Self-Treatment with Helminths: Current Practices and Experience, Journal of Evolutionary Medicine, Vol 3, ID 235910
- ↑ Svoboda E (2008) The Worms Crawl In, Scientist Studies Whether Hookworms Can Protect Against Allergies, The New York Times
- ↑ 11.0 11.1 Elliot DE and Weinstock JV (2012) Helminth-host immunological interactions: prevention and control of immune-mediated diseases, Ann N Y Acad Sci; 1247:83-96
- ↑ 12.0 12.1 Bashi T et al (2014) The Mechanisms behind helminths immunomodulation in autoimmunity, Autoimmunity Reviews, 10.1016/j.autrev.2014.10.004
- ↑ Weinstock JV and Elliott DE (2013) Translatability of helminth therapy in inflammatory bowel diseases, International Journal for Parasitology, 43; 245-251
- ↑ Wammes LJ et al (2014) Helminth therapy or elimination: epidemiological, immunological and clinical considerations, Lancet Infectious Diseases, 10.1016/s1473-3099(14)70771-6
- ↑ Helmby H (2015) Human helminth therapy to treat inflammatory disorders – where do we stand? BMC Immunology, 10.1186/s12865-015-0074-3
- ↑ Maizels RM (2016) Parasitic helminth infections and the control of human allergic and autoimmune disorders, Clin Microbiol Infect, 22:481-486
- ↑ 17.0 17.1 Parker W and Ollerton J (2016) Evolutionary biology and anthropology suggest biome reconstitution as a necessary approach toward dealing with immune disorders, Evolution, Medicine and Public Health, 10/1093/emph/eot008
- ↑ Wolff MJ et al (2012) Helminthic therapy: improving mucosal barrier function, Trends Parasitol, 28(5):187-194
- ↑ Sipahi AM and Baptista DM (2017) Helminths as an alternative therapy for intestinal diseases, World Journal of Gastroenterology, 23(33):6009-6015
- ↑ Jenkins TP et al (2017) Infections by human gastrointestinal helminths are associated with changes in faecal microbiota diversity ad composition, PLOS ONE, 10.1371/journal.pone.0184719
- ↑ Fallon PG and Mangan NE (2007) Supression of Th2-Type allergic reactions by helminth infection, Nature Immunology, 7:220-230
- ↑ Mulcachy G et al (2004) Helminths at mucosal barriers – interaction with the immune system, Advanced Drug Delivery Reviews 56, 853-868
- ↑ Chow SC et al (2000) The human hookworm pathogen Necator americanus induces apoptosis in T lymphocytes, Parasite Immunology, 22:29-37
- ↑ Smallwood TB et al (2017) Helminth Immunomodulation in Autoimmune Disease, frontiers in Immunology, 10.3389/fimmu.2017.00453
- ↑ Fasano A (2012) Leaky Gut and Autoimmune Diseases, Clinic Rev Allerg Immunol 42:71-78 10.1007/s12016-011-8291-x
- ↑ Zacharski LR (2014) Ferrotoxic Disease: The Next Great Public Health Challenge, Clinical Chemistry, 60:11; 1362-1364
- ↑ Crompton DWT and Whitehead RR (1993) Hookworm infections and human iron metabolism, Parasitology, 107, S137-S145
- ↑ Raison CL et al (2010) Inflammation, Sanitation and Consternation, Loss of contact with coevolved, tolerogenic microorganisms and the pathophysiology and treatment of major depression, Arch Gen Psychiatry, 67(12):1211-1224
- ↑ Abdoli A and Rasti Sima (2017) Cardioprotective manifestations of chronic helminth infections: new aspects of an old disease, Heart, 103: 1651