Selecting a therapeutic helminth

    From Helminthic Therapy wiki

    Considerations when choosing a therapeutic helminth

    Where the different therapeutic helminth species live in humans

    The four species are most likely to be found where the red text appears in the following representations of the human digestive tract.

    NA (See here for further details.)

    mouth ➤ oesophagus ➤ stomach ➤ duodenumjejunumileumcaecumascending colontransverse colondescending colon ➤ rectum

    HDC (See here for further details.)

    mouth ➤ oesophagus ➤ stomach ➤ duodenumjejunumileumcaecumascending colontransverse colondescending colon ➤ rectum

    TSO (See here for further details.)

    mouth ➤ oesophagus ➤ stomach ➤ duodenumjejunumileumcaecumascending colontransverse colondescending colon ➤ rectum

    TTO (See here for further details.)

    mouth ➤ oesophagus ➤ stomach ➤ duodenumjejunumileumcaecumascending colontransverse colondescending colon ➤ rectum

    Perhaps related to their preferred locations, NA are particularly effective against inflammatory conditions affecting of the smmall intestine, such as Crohn's disease, and the whipworms, TSO and TTO, are especially effective against colonic diseaes like colitis. All helminths also have some degree of systemic effect.

    Species that have shown benefits in common medical conditions

    There is no single "best" worm or worm combination for all conditions, but some worms do have a better track record with certain diseases. [1]

    The following details, based on anecdotal reports, offer a rough guide to which species might be best to try first in some of the most common medical conditions.

    Species shown in bold type are generally more likely to help, but this can vary between individuals.

    Alopecia areata - HDC / TSO
    Ankylosing spondylitis - NA / TSO
    Asthma - NA / HDC / TSO
    Autism - TSO / HDC (NA may help with some of the co-morbidities of autism.) See more
    Autoimmune diseases - NA / TSO / HDC
    Allergies, contact - TSO / NA / HDC
    Allergies, food - TSO / NA / HDC
    Allergies, seasonal/environmental - NA / HDC / TSO
    Celiac (coeliac) disease - NA / TSO / HDC
    Chemical sensitivity - NA / TSO
    Chronic fatigue syndrome (CFS) - NA / HDC / TSO. See more
    Colitis (including ulcerative colitis, pancolitis, Crohn's colitis) - TSO / TTO / HDC / NA
    Crohn’s disease - NA / TSO / HDC
    Depression - NA / HDC / TSO
    Gut microbiome disruption due to chemotherapy. TSO [2]
    Eczema - NA / HDC
    Eosinophilic esophagitis (EE/EoE) - NA / TSO
    Fatigue - NA / TSO
    Food intolerance / sensitivity - NA / TSO / HDC
    Inflammatory bowel disease (IBD). See separate entries for Crohn's disease and colitis.
    Insomnia - NA / HDC / TSO
    Irritable bowel syndrome (IBS) - TSO / NA / HDC
    Lichenoid eruption, Lichen planus, Lichen ruber - TSO
    Lupus - TSO / NA
    Migraine - NA / HDC / TSO
    Multiple chemical sensitivity (MCS) - NA / TSO
    Multiple sclerosis, relapsing-remitting (RRMS) - NA / TSO / HDC
    Multiple sclerosis, progressive (PPMS and SPMS) - NA / TSO / HDC
    Myalgic encephalomyelitis/encephalitis (M.E./ME) - NA / HDC / TSO. See more
    Neuropsychiatric disorders (e.g., depression, anxiety, bipolar, etc.) - HDC / NA / TSO
    Psoriasis, psoriatic arthritis (PsA) - NA
    Restless legs syndrome - NA / TSO
    Rheumatoid arthritis - TSO / NA
    Sjögren's syndrome, primary (pSS) - NA
    Sjögren's syndrome, secondary (sSS) - NA / TSO

    Further insights to help with species selection can be found in the following resources.

    This page shows which worm species have been used by self-treaters reporting success with each of the listed conditions.
    Table 2 of this paper contains details about the effectiveness of each worm species in the treatment of the conditions listed, as reported by self-treaters who were surveyed in the study.
    Table 3 shows the percentage success rate of each worm species in the treatment of the listed conditions, based on information collected from publicly available sources.

    Even with the benefit of the details presented above, personal experimentation may still be required in order to establish exactly which worm, or worm combination, will be best in the longterm for each self-treater.

    The hardest part of this therapy imo is figuring what helmith(s) are best for you and the dosing because everyone’s different. [3]
    There's just the simple thing of what you respond to best. It’s not good or bad about species, but just about you. [4]

    The further details presented below should provide additional help in selecting a worm to try first.

    The scientific evidence

    There have been no head-to-head clinical trials comparing any of the currently available therapeutic helminths, and there may never be any, due to the extremely high cost of mounting such studies and the lack of incentive for anyone to fund them. There is also little scientific evidence for the efficacy of the individual helminths used in therapy, although almost all species of intestinal worm appear to be capable of producing beneficial effects.

    Almost any worm species that has been tested, in almost any animal model of immunity, autoimmunity, or allergy, has given positive data. [5]

    In the groundbreaking Correale and Farez study of 2007 in patients with multiple sclerosis, (Abstract | PDF) all the helminth-infected subjects benefited, even though they had 5 different species of helminth between them. Therefore the type of worm used may not make a great deal of difference to the eventual outcome of helminthic therapy.

    The only organism to be studied in the treatment of autoimmune disease in well designed trials at therapeutic doses is TSO, and this has been shown to be safe and effective in ulcerative colitis, [6] (PDF) promising in the management of Crohn's disease [7] as well as in the treatment of relapsing-remitting multiple sclerosis (RRMS) [8] and also in dampening allergic airway hyper-reactivity. [9] TSO has also shown significant results in 70% of subjects with the inflammatory subtype of autism spectrum disorder (I-ASD) who took TSO in its original pH2.7 form. [10]

    Several other trials of TSO were conducted by the now defunct company, Coronado Biosciences, prior to the termination of its research programme early in 2015 following what appeared to be disappointing results. However, the apparent failure of these trials was likely due to poor trial design, including an inadequate duration of only 12 weeks and, in particular, the insistence by researchers on the use of a novel formulation of TSO with a higher pH than the product that had been employed successfully in previous studies and used to good effect by many thousands of self-treaters for more than a decade. [11], [12] For more details about the later, "unsuccessful" TSO trials, see Problems with clinical trials using live helminths.

    The first trial of the hookworm, NA, to be carried out over a sufficient period of time to allow the worms to mature and produce consistent therapeutic effects was completed in early 2016 at Nottingham University in subjects with relapsing remitting multiple sclerosis (RRMS). Although the particular statistical endpoint determined for this trial was not reached, [13] the data reveal that more than half the patients given NA had not developed any new lesions. [14]

    There have been no clinical trials in humans using the other available therapeutic organisms, TTO and HDC, although there was a detailed case study of an individual with ulcerative colitis who experienced almost complete remission of his symptoms after self-infecting with TTO, [15] and a further case study showing several indicators of mucosal and systemic immune modulation following self infection with TTO. [16] A study in mice showed that Infection with HDC was superior to daily corticosteroids in the prevention of colitis in this species, and that this did not result in any additional side effects. [17]

    The anecdotal evidence

    While data from clinical trials is still limited, the anecdotal evidence gathered by the self-treaters who have pioneered helminthic therapy for more than a decade is already significant and compelling. See Helminthic therapy personal stories and the following paper.

    Apart from this study, there was, for many years, little recorded anecdotal evidence for TSO and HDC, and this was largely because users of these two organisms, and especially TSO, were much less active on helminthic therapy social media sites. In contrast, NA has been discussed extensively online since 2007, and, to a lesser extent, TTO, since 2009, originally on the now defunct Yahoo Helminthic Therapy Forum and, more recently, in the Facebook Helminthic Therapy Support Group.

    NA (Necator americanus)

    There is perhaps no better example of a therapeutic parasite than the hookworm, Necator americanus. [18]

    NA, which has the longest lifespan of the currently available therapeutic helminths, produces powerful systemic immunomodulation and it’s use appears to be effective in approximately 70-80% of cases of autoimmune disease, inflammation and allergy. [19] [20] [21] The extent of its benefits can be seen in the hundreds of reports in the compilation of Helminthic therapy personal stories, most of which are from users of NA.

    This organism causes a short-lived, but often itchy, rash at the inoculation site in most subjects, and may produce a very pleasant, if brief, “bounce” in the first few weeks following inoculation, as well as causing other well documented transient side effects during the first few months. (See The hookworm timeline) However, it does not cause any long-term ill effects.

    Concern is sometimes expressed about the safety of self-infection with NA, and it has been claimed that this species can act as a vector for pathogens and mis-migrate to organs outside the digestive tract, but neither of these claims is true. Nor is anaemia/anemia an issue for the vast majority of well-nourished NA hosts, and the “tissue damage” caused by hookworms needs to be seen in context. For more detail about all these issues, see The safety of NA.

    For information about the use of NA, see the following pages.

    TTO (Trichuris trichiura ova)

    The colon-dwelling Trichuris trichiura, which has an effect that is less systemic than that of NA and more localised in the colon, is most frequently employed in the treatment of ulcerative colitis and colonic Crohn’s disease. Its effect on these disorders may be related to its ability to reduce the inflammatory Bacteroides species which are thought to be involved in the aetiology of inflammatory bowel disease. [22]

    Some people with colonic diseases seem to do well using TTO alone.

    I just got word after the last colonoscopy that my pan colitis is fully disappeared. After nearly a decade of failed treatments, I am fine thanks to a course of TTO. [23]

    But many others have found it best to combine TTO with NA.

    I successfully take hookworm and TTO to keep my UC in remission. I take 10 NA every four months and 50 TTO eggs every two weeks. [24]
    The TTO I think help my colonic issues the most and the NA help with some of the systemic/allergic issues I've had and my overall mood (they help me feel relaxed and often euphoric). [25]
    We have noticed a bigger improvement since my daughter has got her hookworm levels to above 80, in combination with whipworms. I think they really help the inflammation. [26]
    I have Crohn's in my large intestine but for whatever reason NA seems to do most of the heavy lifting for treating my disease. However the TTO does help. [27]
    I get 70% decrease in my Crohn's symptoms with NA, but it doesn’t fix diarrhea, which TTO did. [28]
    I didn’t get dramatic results from NA so I added TTO. Treating unspecified AI which attacks tendons of shoulders and hips, bladder irritation (IC), dry eye, facial flushing, fatigue, headaches, intermittent plantar fasciitis, patellar tracking disfunction, chemical sensitivity, dairy allergy, seasonal dust and animal dander allergies, metabolic syndrome, and tinnitus. I also have mild trouble absorbing nutrients and GERD. I quit all dairy and gluten. Started with NA and then added TTO about six months in. The difference has been that I recover from physical activity better, my CRP is down, my eosinophils are in the high normal range, and I just feel more balanced and like my G.I. system is peaceful. There is some transient inflammation when TTO’s are taken, and some rank gas for 1-2 days... My cravings changed after I took TTO. Now I don’t eat as much or crave sugar like I did before. [29]

    Some people with colonic diseases have had more success using NA alone.

    I'm someone with UC, and NA keeps me in remission. For some people, TTO is way better, but I think the NA is doing the magic for me. [30]
    I have small periodic UC flares. The first lot of 3 NA gave me a flare for 2 weeks but since then I have not had anything at all. [31]

    A few people have reported being less well after adding TTO to an existing colony of NA, [32] but a few others have felt less well after adding NA on top of TTO. [33]

    Some people who have tried both TTO and TSO have found the human species to be more effective.

    I previously tried TSO and it dampened the UC somewhat, but not to the extent that human whipworms (TT) have. TSO, however, never caused me any side effects. But the cost of TSO is insanely astronomical to anyone but a millionaire, and I suspect that colonization by the worms does indeed bring on a higher level of therapeutic value. [34]

    Although TT is used primarily in the treatment of diseases affecting the colon, and its systemic effect is less than that of NA, its immune modulation can nevertheless produce benefits beyond the intestine, [35] so may assist in the remediation of diseases elsewhere in the body, in a way similar to how its close relative, TS (Trichuris suis, which also lives in the colon) is able to reduce the number of brain lesions in MS patients. [36]

    Since TT produces significant changes in the composition and relative abundance of gut bacterial species, [37] it is possible that it may also help to ameliorate any condition that is driven by intestinal dysbiosis, such as obesity, diabetes (type I and type II), cancer and neurological disorders.

    For information about the use of TTO, see the following page.

    TSO (Trichuris suis ova)

    TSO has a localised effect in the colon [38] similar to that of TTO, so is particularly effective in the treatment of diseases affecting this section of the intestine, such as ulcerative colitis. It has also proved to be effective against autoimmune disorders affecting other parts of the body, especially Lupus and Crohn’s disease [39] but may not be as effective against MS as NA. [40] TSO can also be effective in autism, [41][42][43] perhaps more so than any of the other worms, [44] although the extent of its effect is dependent on the sub-type of autism exhibited, [45] and NA is reportedly helpful in addressing some of the medical co-morbidities that accompany autism. [46]

    TSO has been reported to efficiently dampen allergic airway hyper-reactivity [47] and has been claimed to be very effective in the treatment of food and contact allergies, [48] although less effective than NA against seasonal allergies. One user has reported that she found TSO was a huge help with joint and hip pain caused by eating nightshades, especially chilies and peppers. However, while NA had allowed her to resume eating nightshades, it had not helped with aching and stiffness in her joints. These symptoms only resolved after she added TSO. [49]

    TSO does not work as quickly when taken by someone who has previously used NA, so anyone who is unsure which helminth species to use should ideally start with TSO, then add, or switch to, NA, if necessary, at a later date. [50]

    Approximately 80% of people who take at least one full course of TSO (10 doses of 2,500 ova, with one dose being taken every 2 weeks) may achieve disease remission and, according to the producer of TSO, around 60% of these subjects will continue to experience remission for between 1 and 3 years. This was demonstrated by the experience of one TSO user.

    I finished taking them in mid 2013 and am seeing the effects starting to wear off now (late 2015), so the 10 doses appear to last for about 2 years. [51]

    During this time, some users of TSO may not need any further doses at all, while others might need to take a periodic maintenance dose, for example 500 TSO every month, [52] or every 2 months. [53] This has allowed some subjects to maintain remission for many years, although the level of success is likely to depend on the severity of a subject’s condition at the start of treatment. One individual with ulcerative colitis has reported being in remission for 9 years after taking a single course of TSO during a clinical trial.

    There are, however, some users of TSO who do not continue to experience benefit after completing a course of 10 doses.

    I did not go into remission though with 10 doses of 2500 TSO. [54]

    These individuals may need to maintain the treatment long-term.

    For information about the use of TSO, see the following page.

    HDC (Hymenolepis diminuta cysticercoids)

    While anecdotal evidence about this latest addition to the list of therapeutic organisms is still limited in comparison with that available for NA and TT, posts to the helminthic therapy groups indicate that the HDC experience follows a similar course to that seen with other helminths, beginning with the possibility of initial transient side effects and leading to eventual success in many cases.

    As with the other therapeutic helminths, HDC can cause initial side effects, some of which have been found to be quite challenging by a few users.

    HDC does not have less side effects for everyone, it caused me a huge amount of discomfort. [55]

    And it has been reported that approximately 1% of paediatric patients may experience severe gastrointestinal pains with the use of HDC, although these symptoms are resolved by the administration of an anthelmintic drug. [56]

    A number of successes have been reported by HDC users, e.g.,

    … my hay fever has been much better on HDC. Barely noticed it this year. [57]

    as well as some failures, e.g.,

    … I’m on HDC and they do not seem to help with food reactions sadly, i was ready to run for a 1kg bar of chocolate in the name of science!

    There are reports from subjects who have previously used NA that the effects of HDC can be more gentle and subtle than those produced by hookworms.

    “HDC seemed gentler / more subtle all around than NA

    but others have obtained more relief after adding, or switching to, NA.

    One helminthic therapist has reported that, in her experience, HDC is the most calming on the gut of all the helminths, citing someone with chronic diarrhoea who had excellent relief from HDC. [58]

    After I’d been taking HDC for a while and established that there is no extra benefit for me in hosting HDC as well as NA, I killed off the hookworms to see what the HDC could do on their own. Unfortunately, nasal congestion returned within 48 hours of terminating the NA, and this persisted to such an extent that, after 5 weeks, I was desperate to restock with hookworms. Within two days of taking a dose of 40 HW larvae, the congestion receded. In the weeks that followed, I experienced symptoms that are typical after inoculating with NA, indicating that the HDC, which I had continued to take, were not effectively modifying my immune response to the new NA.

    HDC users frequently report a welcome elevation in mood, especially in the first few days after inoculation.

    I like how it (HDC) puts me in a good mood for a day or two when I first take it.

    However, HDC can occasionally have an adverse effect on mood.

    The response I had from the HDC was sweating, feeling sick but it was also especially agitation and depression. [59]

    As larger numbers have begun using HDCs, more reports of adverse side effects have emerged. These have revealed transient problems very similar to those seen with hookworms, but have also included reports of a need for larger doses once the “honeymoon period” of the first 6 months is over, and continuing into the long term.

    The fact that a fresh dose of HDC needs to be taken every two weeks, coupled with their very short shelf life, means that maintaining a regular dosing schedule can be an issue with this species.

    I did once miss a dose for 30 days, and there was hell to pay on that account. My immune system went crazy for about a week, until I could get a new dose. [60]

    More examples of users’ experience with HDC can be found in The HDC experience.

    In June 2016, a researcher at Duke University commented that William Parker’s team had been unable to determine much difference between the effect of HDC and TSO. [61]

    For information about the use of HDC, see the following pages.

    Comparing human helminths with non-human helminths

    NA and TT have both become very well adapted to living in humans during millions of years of cohabitation and coevolution with mankind. This longstanding relationship allows them to grow to maturity in the human gut and enter into an ongoing, dynamic, two-way chemical dialogue with their host’s immune system. The resulting immune modulation prevents the worms from being overwhelmed, and provides their host with benefits that are maintained for as long as the worms survive.

    The survival of human helminths depends to a large extent on the vigour of the host’s immune response. NA is reported to survive for 3-10 years [62] [63] but to be capable of living for up to 15 years, [64] and possibly even 18 years. [65] However, in a few hosts, it may die in as little as three months. (For more about this, see Hookworm lifespan.) TT can survive for more than 2 years, and occasionally in excess of 5 years. [66] There has even been one report of TT showing up during colonoscopy 7 years after inoculation, but they are more likely to die in under a year. [67]

    TSO and HDC are both adapted to non-human species, the natural host of the former being the pig, and the latter normally being found in rats. As the human gut is an alien environment for both these organisms, they only survive in humans for a short time, typically just a couple of weeks, during which time the molecules they excrete/secrete distract the host’s immune system.

    The fact that TSO and HDC rarely mature in humans has led some commentators to speculate that these nonhuman helminths may not be as effective, therapeutically, as the human-adapted worms, NA and TT, and it may be that helminth efficacy is enhanced in the case of mature, egg-producing worms. [68]

    The view that human-adapted helminths such as NA and TT might be more effective, therapeutically, than nonhuman worms like TSO and HDC, was discussed in detail in a support group thread. [69] This idea has also received support from William Parker, who has referred to human helminths as our true “old friends”, and TSO, HDC and other helminths that prefer non-human hosts as, at best, our "old semi-acquaintances".

    People who have switched from using TSO or HDC to either NA or TT have often done so because they are much cheaper. However, many who have made this transition have subsequently commented that they have found the therapeutic benefits of NA and TTO to be greater than those of TSO or HDC.

    I previously tried TSO and it dampened the UC somewhat, but not to the extent that human whipworms (TT) have. [70]
    I tried pig whipworm way back but it had zero effect on me. It wasn’t until I got on human worms (both NA and TT) that I saw the extreme positive effects that the worms give. [71]
    I have UC and tried TSO for 6 months with no results. But 10 NA works like a charm. [72]
    I tried to take other species when I lost my NA - I tried TSO and HDC, sadly they do not have the same effect for me. [73]
    I'm at week 18 on NA and I have to say by this moment in time my results with HDC were quicker and flashier (more obvious) but on NA I feel more stable, no more crashes. [74]

    However, there are others whose experience has led them to prefer a non-human helminth.

    I have tried 3 helminth species. NA, TTO and TSO. I started with TSO and it put my Crohn's disease into remission within 3 months. I tried using only NA when I was completely well. It did not work, and the side effects were too much for me. Extreme fatigue. TT works for me too, but it's more of a challenge to figure out dosage and timing. It takes time to for them to mature and I have to overlap TT with TSO to ensure I had no gaps that would induce symptom recurrence. My body responds best to TSO. I find it to be the most gentle with no side effects. [75]

    Response time

    All four helminth species have shown themselves to be capable of producing surprisingly rapid results in some cases, although benefits rarely become consistent with the human helminths, NA and TTO, until at least 12 weeks after the first inoculation.

    Some self-treaters have reported that the non-human helminths, TSO and HDC, have produced benefits more rapidly than NA and TTO.

    TSO relieves my symptoms the quickest of all helminths. [76]
    They (TSO) started working after the second dose. [77]
    I started with 2,500 TSO every two weeks and saw improvement in 11 days. It took me about 16½ months to get to that same level of improvement with the human worms. [78]
    HDC is very fast acting for me... By the 3rd or 4th day my burning sore lungs are no longer sore. [79]
    I was a very fast responder to HDC. It was amazing. I did not have the same reaction to NA. [80]

    While evidence from clinical trials is still lacking, feedback reported by one researcher and a commercial supplier of HDC suggests that a significant proportion of people using this species seem to respond in days or weeks rather than months, and this provider advises clients that, if they have not experienced any benefit in 12-16 weeks, it is unlikely they will see a positive response.

    However, HDC and TSO have not always delivered benefits so quickly.

    TSO took 4½ months to kick in for me...
    ... about this assumption that HDC works faster. It definitely doesn't for me.” [81]

    And there are reports of NA delivering rapid benefits in some cases.

    It's been exactly a week since my first inoculation of 25 HW... my asthma got much better at day 2. Also my allergies seem to have gotten a little better... I feel great right now actually. Its awesome to be able to breathe in a 100%! [82]
    On the second day after my new gut buddies (NA) moved in, their ministrations brought significant relief from the nasal congestion that I had had, on and off, for most of my life.” [83]

    Shelf life

    HDC. After extraction from beetles, HDC will not remain viable for more than 48 hours if kept in saline, but will survive for 2 to 3 weeks if stored in the special nutrient solution developed for this species by Biome Restoration. Unless such a solution is used, HDC deteriorate rapidly after extraction. Fresh HDC should therefore be used within 24 hours of being harvested - not 24 hours after receipt. For more detail, see Storage and survival of HDC.

    NA. NA larvae can survive for as long as 3-5 months if kept at a temperature of 60-65°F (15-18°C), [84] [85] but, ideally, should be used as soon as they are available. L3 larvae do not feed, so are reliant on their fat stores, which obviously diminish over time, rendering them progressively weaker. For more detail, see Storage and survival of hookworm larvae.

    TSO / TTO. Whipworm ova (both TSO and TTO) can remain viable for a couple of years if stored in a refrigerator, so keeping a supply of these in reserve can be a useful insurance for users of NA against the loss of their colony, or an interruption in its benefits following the use of antibiotics. Since TSO usually produces results more rapidly than TTO, this is the ideal species to keep for such an emergency.

    I keep TSO for emergencies, such as, if I have to take antibiotics, or I accidentally ingest something that harms my (human) helminths. [86]

    Dosing frequency

    The non-human helminths (TSO and HDC) need to be re-dosed every 2 or 3 weeks in most cases. A disadvantage of the need for such regular re-dosing is that self-treaters can forget to take doses, and a few HDC users have reported experiencing a return of symptoms as a result of deviating from the usual fortnightly dosing regimen. These include the mother of a child with Crohn’s disease who reported that her son began to bleed on two occasions as a result of delays in taking his doses of HDC. Others have reported suffering a sudden return of symptoms due to delays in taking HDC.

    Missed a dose, no fault of anyone, life just got in the way... Been w/o for a month. Horrific dysautonomia, which is constant dizziness, neck pain... [87]
    I did once miss a dose for 30 days, and there was hell to pay on that account. My immune system went crazy for about a week, until I could get a new dose. [88]

    It is also possible to forget to re-dose with NA and TTO but, since human worms don’t usually all die at the same time, the return of symptoms in their case is normally much more gradual, so users of NA and TTO can forget about dosing until they begin to see a gradual return of the symptoms of their disease, which typically only occurs every few years.

    Hosting multiple worm species

    It is clear, both from scientific studies and the personal experience of helminthic therapy self-treaters, that a single species of worm is all that is required in most cases to modulate host immunity and halt existing immune-related disorders, as well as protecting the host from the development of many other conditions associated with a helminth deficiency. And it has been shown that the beneficial effect of helminths is not specific to any single helminth species. [89] However, different species of helminth can produce somewhat different effects.

    I reacted to HDC and HW completely different... [90]
    I think NA helps tamp down inflammation overall and gives the TTO a chance to take hold. I think NA helps with stool formation while TTO heals colon ulcers, thus stopping blood and mucus loss, restoring gut wall. [91]

    It is possible that hosting one species of helminth might reduce a host's susceptibility to infection by other parasites, [92] although no difficulty has been reported by self-treaters in becoming colonised by a second, or third, species of therapeutic helminth.

    Combining two species

    There are several reasons why self-treaters might consider adding a second species.

    To speed up the initial response to helminthic therapy

    Starting with a non-human helminth species - either TSO or HDC - could help to ensure a more rapid response in preparation for eventual long-term therapy with either NA or TT.

    I do think starting with TSO is great because you get a therapeutic colony right away. Also, I think having the TSO on board minimizes side effects from the human worms.” [93]

    However, introducing two species together when first beginning helminthic therapy can result in greatly increased side effects. Therefore, The first inoculation should be with a single species.

    To increase benefits

    Exposure to two worm species at the same time - provided that one of these has already been established - may promote even stronger immunological regulation [94] [95] and this has been confirmed by self-treaters.

    HDC and NA make a powerful combo for me that reduces symptoms even more than NA alone. [96]
    In my case NA have helped with arthritis. After adding frequent small doses of HDC on top, it’s gone. [97]

    Combining two species can provide a greater range of benefits.

    I use both NA and HDC and find that they affect me in different ways. NA affects my hormones (period symptoms change), dental health (less inflammation), and skin (less keratosis pilaris). The HDC affects my mental health, which is the main thing I was hoping to address. [98]

    When combining two species, it may not be necessary to dose both of them at the same level. For example, if adding TSO to an existing colony of NA, additional benefits may be gained by using only very small doses of TSO. Even a dose of 250 TSO, taken once every 2 weeks, can deliver significant additional benefits to hosts of other species.

    Small doses of TSO can be created easily by dividing the contents of a bottle containing a larger dose. This is explained here: Dividing doses.

    To mitigate unwanted effects caused by a different species

    The addition of a second species can sometimes modulate unwanted effects caused by another species. For example, one individual who had experienced increased anxiety after initially inoculating with NA was able to resolve this by adding TSO.

    ... adding TSO helped me enormously with anxiety. [99]

    To reduce the attrition of another species

    One particular benefit provided by hosting a second species of therapeutic helminth is that this may help to reduce the increased attrition sometimes experienced in cases where subjects have a disease affecting the preferred location of the worm species they are already using. For example, subjects with Crohn’s disease are susceptible to inflammation in the small intestine, which is where NA resides, with the result that this species can have more difficulty attaching in order to feed. Consequently, they tend not to survive in Crohn’s patients for as long as they might do in hosts with other diseases.

    It may therefore be advantageous for Crohn’s sufferers to host a second species that lives elsewhere, such as TT or TSO, both of which live in the colon. Similarly, subjects using TT to treat colitis may have difficulty maintaining a whipworm colony due to colonic inflammation hampering attachment by these worms, in which case they might benefit from also hosting NA which contribute systemic inflammation control.

    To offset the effects of a sudden loss of human worms

    TSO or HDC could be useful to hosts of NA if their colony were to sustain accidental losses, for example following the use of some types of antibiotic or after inadvertently ingesting a food or other substance with anthelmintic effects.

    … what really helped her … was 2 doses of TSO that she had while waiting for the (hookworm) colony to start working again. [100]
    4 days after swallowing a small dose of TSO (250 ova), I am feeling much more relieved of my diarrhea, which had been punishing me for 2 or 3 months, since I accidentally ingested coconut oil, which probably killed a good part of my NA colony. [101]

    TSO is ideal for this purpose since, unlike HDC, this organism remains viable for years if kept in a refrigerator. A supply of TSO can therefore be kept in reserve by users of NA to provide assurance that they will never be without the benefits of worms.

    Keeping TSO on hand to bridge the gap while rebuilding a (hookworm) colony works for me too. [102]

    Keeping a different species of worm in reserve may not be necessary for users of TT, if they are dosing on a regular basis, because they will usually have a supply of TTO in their fridge that they can reach for if required.

    To modulate the severity of an NA inoculation rash

    One NA host has found that taking a small dose of 250 TSO two hours before inoculating with NA reduces his skin response to the hookworms, perhaps by distracting his immune system from the activity at the inoculation site. For how to divide the contents of a bottle of TSO to create small doses, see the details here: Dividing doses.

    Two more NA hosts have found that, while regularly taking 250 TSO every 2 weeks, their NA inoculation rashes have resolved much more quickly. They both commented, in particular, on a marked shortening of the oozing stage.

    And a fourth self-treater has had success with even a very small dose of TSO.

    I’ve found that a small dose of TSO dulls the rash considerably (anywhere from 25+ ova). [103]

    The ideal species combination varies between individuals

    Experience has shown that different individuals can require different combinations of species, so experimentation is required.

    I have found that my best combination is 1250 TSO every 2 weeks and 5-7 NA every 6 weeks. [104]
    My best regime was a combination of frequent NA with 2,500 TSO fortnightly. Now doing 10-20 NA monthly and HDC slowly climbing up to 20. (TSO got expensive for me, so I’m trialling HDC because potentially in the long run I’ll get some rats and grow them myself.) (Edited from two posts: [105] [106].)

    Combining two species may not benefit everyone

    I tried HDC in addition to NA several times and didn't have much success; in fact, I believe it twice triggered flares… I have had very positive experiences with NA alone. (Link expired)
    I went off NA because it was not getting me all the way to remission and combining it with other kinds of worms, either TSO or HDC, was just creating a situation where I got side effects and my arthritis would start flaring up again. So it seems taking two kinds of worms just doesn't work for me. [107]

    Switching between two species

    If switching from one species to another, there may be a hiatus in benefits until the new species is able to fully take control of immune modulation.

    I took HDC for a year. HDC worked really great. I felt very well... Changing from HDC to TSO was like starting from scratch. All my symptoms came back and took 4½ months to get back to where my best was while taking HDC. [108]

    Because of this, it is advisable to maintain the existing dosing regimen for the established species until the new one ceases to cause any side effects.

    It would also be advisable to initially limit the dose size of the new species to further minimise the risk of side effects.

    Combining three or more species

    Adding a third therapeutic helminth has worked well for one self-treater.

    I use 3 species of helminths and each one has particular characteristics and effects. [109]

    There has been very little research into the results of hosting more than two species of helminth at one time, but, according to one study, the outcome of interactions between two parasite species can be significantly modified by the addition of a third, and the consequences of this may not always be desirable. In this study, investigators were looking at the effects of co-infection by four gastrointestinal helminth species on the development of cerebral malaria among Plasmodium falciparum-infected patients, and they found that the addition of a third species led to a reduction in one of the benefits provided by an existing species.

    The study found that, while infection by TT and the non-therapeutic helminth, Ascaris lumbricoides, were both associated with direct reductions in cerebral malaria risk, this benefit of TT infection was halved in the presence of hookworms, revealing a strong indirect effect. [110]

    Obtaining helminths

    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.

    None of the helminth providers 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 longer term contracts. Therefore, the details for each provider need to be carefully scrutinised before making a decision about which source to use.

    See also

    ... weighing potential cost/benefit ratios of various helminths along with other factors, such as feasibility of production, we argue that the four helminths currently in use for CIAD treatments in humans were selected more by happenstance than by design, and that other candidates not yet tested may prove superior.