Self-treating with TSO

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The porcine (pig) whipworm, Trichuris suis, is supplied in small bottles containing 15ml of an isotonic, phosphate buffered saline solution at pH 2.4. Suspended in this liquid are minute, barely visible eggs that are referred to as ova, hence the abbreviation, "TSO". Since this species is not adapted to living in humans, it dies approximately 14 days after ingestion, following which it is completely digested, leaving no eggs or worms to be passed in faeces. During its short time in the body, the immature worm hatches from its egg and begins to grow, shedding molecules that modulate the host’s immune system and provide a legitimate target for it to attack. This prevents the immune system from responding inappropriately to innocent targets such as foods and pollens and the host’s own tissues, as happens in autoimmune diseases such as lupus, ulcerative colitis and Crohn’s disease.

Dosing with TSO

Taking TSO

TSO are taken orally by drinking the contents of a 30 ml bottle that holds the eggs in 15 ml of saline solution.

Taking TSO on an empty stomach will allow the eggs to move through the digestive tract a little more quickly and hatch a little earlier than if they had been delayed while a meal is being digested, but this small saving of time is the only benefit of taking them between meals. [1]

I take mine at anytime. I do not worry about what I have eaten or time of day. TSO is bullet proof 💪 [2]

Just drink it, and refill and shake the bottle a couple times. [3]

I've been just drinking it from the bottle... then I add some water, cap and shake, drink, repeat several times. [4]

I mix it in some water and drink it that way [5]

I usually take it with a glass of smoothie. But sometimes just in water. [6]

Available dose sizes

500 ova

1,000 ova

2,500 ova

Dividing doses

Small doses of TSO can be created easily by dividing the contents of a bottle containing a larger dose. For example, after first shaking the bottle to evenly distribute the organisms it contains, doses of 500 TSO can be created from a bottle of 1,000 TSO by carefully pouring out half of its contents. But, if using a bottle of 2,500 ova to create five doses of 500, it's best not to attempt to pour out a fifth of the liquid by sight. Instead, after shaking the bottle, use a medicine syringe to immediately draw up 3 ml of the liquid for each dose of 500 TSO. Similarly, doses of 250 can be created from a bottle of 2,500 TSO by shaking the bottle and then immediately drawing off 1.5 ml using a medicine syringe. The bottle, containing any remaining ova, should be stored in the fridge until next required.

Recommended dosing regimens

The basic dosing regimen recommended by the manufacturer consists of 10 doses of 2,500 TSO, one dose being taken every 14 days. This dosing is the result of early clinical trials with this organism [7] [8] [9] [10] combined with over two decades of experience on the part of Tanawisa staff in working with users of TSO.

In cases of more severe or chronic disease, up to 20 doses of 2,500 TSO may be necessary. Alternatively, if a full course of 10 fortnightly doses of 2,500 TSO has not resulted in complete disease remission but has been well tolerated, it is safe to increase the dosage, first to 5,000 TSO every two weeks, and, if necessary, even to 7,500 TSO fortnightly. These higher doses have brought success in most cases where doses of 2,500 TSO had failed to achieve remission, (e.g., [11]) but it is always best to start with 10 doses of 2,500 TSO and only escalate the dosage after 10 weeks (5 doses), if this is necessary. [12]

Some people have found that they begin to experience a return of disease symptoms slightly before the next dose is due. In these cases, shortening the period between doses by one or two days will prevent the reappearance of symptoms.

I did shorten the cycle to every 12 days for few months since my (ulcerative colitis) symptoms had a tendency to come back just before the 14 days mark. It did help. After few months I was able to go back to the regular 14 days cycle. [13]

Alternatively, each bottle of 2,500 can be divided into two doses of 1,250 ova, each of which is taken weekly.

I do weekly tso. I do 1250 a week and have done so for the past 6 weeks. It decreased the severity of any side effects I experienced. [14]

Small doses can sometime be effective

It may not be necessary in all cases to use the dosing regimens described above. Unless the need for treatment is urgent - for example in cases where IBD is flaring - smaller doses of perhaps of 500 or 1,000 TSO can be tried first, and this may make the use of TSO more affordable.

I wish I had started at a much lower dose, and built up to my ideal quantity. Then perhaps I could keep buying them now. [15]

If the use of smaller doses brings no significant improvement in the condition being treated by the 5th dose, the number of TSO being taken can be escalated to the next higher dose.

I have seen several autistic patients showing nothing on lower doses, but as soon as they reached TSO2500 the response was great. [16]

Even very small doses can have a beneficial effect in some cases.

I was already taking antihistamines before the TSO, to help with allergic symptoms. Then I ran out during my first TSO course and noticed to my surprise they didn't come back. I hadn't expected TSO to work at just 100 ova. [17]

Children under 3 years old

In this group, a physician should be involved in decisions about dosing.

Children aged 3 and over

TSO should be introduced using very small doses that are taken every 2 weeks and increased gradually over a 10 week period. These doses should be measured using a 5ml pipette purchased from any drugstore. The whole protocol will require a total of 5 bottles of 500 TSO and 3 bottles of 1,000 TSO.

Dose 1. Take a bottle of 500 TSO, shake this well, and then take out 3ml of the solution using the pipette, drop the liquid onto a spoon or mix it with any drink, and administer. Then store the bottle in a fridge, NOT a freezer.
Dose 2. After 2 weeks, repeat as described for dose 1, but take out 6ml.
Dose 3. After another 2 weeks, take out 9ml.
Dose 4. After another 2 weeks, take out 12 ml.
Dose 5. After another 2 weeks, give one full dose of 500 TSO.
Dose 6. After another 2 weeks, give one full dose of 500 TSO.
Dose 7. After another 2 weeks, give one full dose of 500 TSO.
Dose 8. After another 2 weeks, give one full dose of 1,000 TSO.
Dose 9. After another 2 weeks, give one full dose of 1,000 TSO.
Dose 10. After another 2 weeks, give one full dose of 1,000 TSO.

After a further 2 weeks, report progress to Tanawisa, who will advise on how to proceed.

It is often unnecessary to continue treatment following the adaptation regimen (see below), but, if further treatment is required, most children will be able to jump to doses of 2,500 TSO at this point.

Young people (8 years and over) with moderate symptoms

One dose of 500 TSO every 14 days.

Adults with moderate symptoms

One dose of 1,000 TSO every 14 days.

The elderly and those with long-term illness

One dose of 2,500 TSO every 14 days.

Hypersensitive individuals

Anyone with one of the conditions listed as Conditions that require a modified approach to helminth dosing should start by trying very small doses. One individual with total food intolerance, and another with a mast cell disorder, each took two doses of just 250 TSO (one tenth of a normal dose) and experienced such severe side effects that they were unable to continue with the treatment at this dose level.

Special applications

Small doses of TSO (see Dividing doses, above) can be used for a number of additional purposes, including:

to complement therapy with a different helminth species. See Hosting multiple worm species.

I started with NA, then added TSO about 8 weeks later. I had great success around 5-6 months after doing both... I stopped TSO for a while and lost some important gains. Started them up again and regained those positive changes. They are essential, for me, for depression, anxiety and joint pain, and probably many more things. Dosing fluctuates, but I’m now on 1250 TSO every 2 weeks and 8-10 NA every 8-9 weeks. [18]

I also take 250 TSO every 11 days with 4 NA for Crohn’s. With other supplements and low dose medication. I found it to be the best balance for myself. [19]

to help modulate the severity of the skin response to inoculation with NA. See, Adding a small dose of TSO.

Re-treated with NA 3 days ago. I took a small dose of TSO (83 ova - 0.5ml from a bottle of 2,500) beforehand. So far it does seem to have helped. Normally the day after treating with NA I get a strong worm flu and feel poorly for 2-3 days. The day after treating with the NA/TSO combo, I felt “normal." [20]

as a temporary replacement for a different helminth, if access to that species is reduced. For example, when one self treater who had been using NA to treat IBS was unable to have hookworm doses shipped to his home in Brazil during the 2020 Covid-19 pandemic, he tried taking a very small dose of TSO and was very pleasantly surprised by the results.

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. [21] [22]

Side effects

As with other helminths, TSO may cause transient side effects when first introduced but, with this particular species, they are usually mild and limited to the period immediately following the first dose. Any longer persistence of side effects is rare, so only reported in a very few cases.

Allergy

While TSO have been found to help treat contact allergies, they can occasionally exacerbate other forms of allergy. This effect is usually only seen temporarily in the early days of treatment, but it can be more persistent.

Without TSO there are definitely fewer allergic-y symptoms…

I used Allegra and had to continue to use it while using TSO. Same for HDC. Surprisingly, NA are the only helminths I don't have to use Allegra with continuously. [23]

Asthma

Have tried all the other (therapeutic helminth species) and they didn't add value (to my existing NA colony). TSO was the most agreeable, though my asthma eventually returned a bit on it. [24]

Gastrointestinal symptoms

Temporary, mild gastrointestinal symptoms, especially diarrhoea and mild spasms, are the most typical side effects. (Although these can be argued to be "effects" rather than "side effects", since they occur as a result of the intestinal flora changing rapidly and radically under the action of the TSO from a dominance by pathogenic bacteria to dominance by beneficial ones. [25])

Diarrhea / diarrhoea

TSO caused me a few days of looser stools and a rumbling gut, then it settled down around the 4 to 5 day mark. [26]

I started with 2500 TSO fortnightly from the outset (for UC). The only side effects I had were one day of mild diarrhoea 3 weeks in. [27]

In a few cases, diarrhoea can be more prolonged.

I did have diarrhea for a solid month at dose 2. [28]

I’m about 4 months in. The first 3 doses were a big struggle, lots of diarrhea and feeling unwell. I honestly struggled for 3 months. I have finally started to feel better. I still have bad days but things improve. It’s been a long process for me. [29] [30]

Constipation

It is very unusual for constipation to be experienced by TSO users, and the following case involving two members of the same family is the only one in which this effect has been reported to a helminthic therapy support group.

I found that for the first month I took the TSO they made motility slightly loose but this has now changed. I'm on an extremely low dose 0.2 mls (33 ova) every two weeks. I find that when the two weeks is almost up the constipation is relieved and when I take the new dose the constipation starts again. My son also experienced constipation on TSO and had to stop. [31]

Gastritis

Someone with a history of gastroparesis and gastritis found that even a small dose of around 200 TSO would cause a severe flare of gastritis requiring large doses of famotidine to keep it under control. These flares would then end suddenly approximately 12 days after taking the TSO, i.e., the point at which they were dying. (Details via private message.)

I did 1 dose at 2500 (TSO) but my gastritis seemed worse so I went down to 1250 every 2 weeks. [32]

I am on TSO for about 6 months, after difficult start I was upping the bi-weekly dose by 100 to max 800 which caused me a whole week of nausea. Previous to that I was on 500-650 for about 2 months. So I returned to about 500 and that seems to be the best dose for me at the moment… but what worries me is the remarkable worsening of the gastritis. [33]

Reflux / heartburn

These side effects, which are also sometimes experienced by users of NA, usually only manifest temporarily during the initial immune activation phase following the first introduction of a helminth, but they can occasionally persist for longer, especially in those with a prior tendency to reflux/GERD, or to gastroparesis. They may even persist in the longterm in a few cases.

I found my heartburn to become progressively more severe to the point of intolerable with TSO and I stopped them. [34]

Another individual, who has reported elsewhere that she believes she had “silent reflux” for a number of years prior to taking TSO, has reported as follows.

I had reflux develop while on the therapy. I have now killed off the worms. Reflux has subsided considerably but still active. So I’m not 100% if it’s causal. [35]

Someone else who took a course of 10 fortnightly doses of TSO, some of which contained 2,500 ova, and some less, stopped after the tenth dose because of increasing heartburn and a lack of any benefits. [36]

Fatigue

Someone new to helminthic therapy who took a first dose of 1,250 TSO was reported to have experienced extreme fatigue following this dose. While they do experience fatigue as part of their regular issues, the level was extreme after introducing the TSO, causing them to miss school and work, and say that they felt awful in a way that was new. [37]

Skin manifestations

Rarely, the skin may be affected temporarily, or there may even be some redness in the throat, after first taking TSO. [38]

Some people can be sensitive to the low pH of the phosphate-buffered saline solution in which TSO are suspended (pH 2.4 - similar to the pH of Coca Cola), but any skin response should resolve quickly, and can be prevented by mixing the TSO with Gatorade, which dilutes the fluid and raises the pH value.

Flaring of existing diseases

I became more agitated with TSO and had more obsessive thoughts. [39]

So, tomorrow I take dose 2 of TSO... My chronic sinus/eustachian issues seem to be flaring. [40]

I take TSO and I experienced mini flares following each dose when I started. It can take a while (a year+) for the immune system to be tempered. [41]

Recapitulation of old injuries and illnesses

As is also the case with NA, TSO may trigger a temporary reoccurrence of old injuries and illnesses.

I'm in the middle of week 3; I did 1000 for the second dose since 500 went fairly well. I have noticed old things flaring up...a wrist injury for dropping a barbell 8 years ago; my interstitial cystitis - which has been quiet for 4 years - flared back up with a vengeance at the end of week 1 and is now settling down; a knee issue I had on and off that was probably part of my overall autoimmune landscape was bothersome for a few days. My colitis is a little flare-y, too, a little blood, gas, and mucus. That, too, is settling a little as of today. Nothing really alarming, although the cystitis was unpleasant. [42]

The one sort of weird thing is an ache in my teeth in areas where I’ve had crowns or other dental work before. It’s not bad, it’s just something I’ve noticed each time I take TSO. [43]

Changes in dreaming habit

One user of TSO has reported experiencing much more vivid dreams during the night following every dose.

The following reports are from someone who introduced NA at the same time as TSO, so may be due to the hookworms rather than the whipworms.

I had another crazy dream. I am really active in these dreams. Running and jumping and crawling and things (that) ankylosing spondylitis has made it difficult to do these past 2 years. [44] Lots of dreams about food! (I eat a restricted diet.) [45] More crazy dreams. I was sprinting with a group of people between buildings. These dreams seem to happen every night since the 1250 tso dose. [46]

Side effect occurrence

Any side effects that are experienced usually occur after the first dose, or the first few doses, decreasing in severity with each successive dose. Sometimes however, side effects may only appear after the third or fourth dose, as happened in the following case.

My third and fourth doses were the worst. I had a lot of cramping, fatigue and diarrhea. I'm now on dose 5 and so much better. [47]

Side effect persistence

Occasionally, brief side effects may continue to appear after each of the first few doses but they gradually reduce in severity and should eventually cease.

I just took my 4th dose (of 2500 TSO to treat ulcerative colitis)… I’ve had some gas issues for the first couple days after the doses. [48] [49]

I’m at 1 month and 3 doses of TSO (treating rheumatoid arthritis and several other conditions). With each dose I have a small bounce followed by a flare on day 3 or 4 with loose bowels. Then my system seems to regulate to what feels like a new normal. [50]

In the first few months I had reactions (looser stools) with each TSO dose. Once my gut healed sufficiently, within 3-4 months, I no longer had any negative reactions, yet I still continue to feel the Bounce for several days with each dose. [51]

Rarely, a TSO user may experience mild side effects following all doses in the long term.

I do get diarrhea the day after dosing. It clears in less than 24 hours. [52]

I feel fine after 3 days of gut upset. [53]

I have Crohn's. I don't get nausea but I will get diarrhea after every HDC or TSO dose. It usually is the 2nd day after swallowing them. Rarely lasts into the 3rd but If I am traveling, I don't risk it. [54]

The effect of adding other species too soon

The risk of initial side effects is increased if additional helminth species are introduced for the first time while still only in the early stages with TSO.

I’m one month post inoculation with 5 HW and one week post inoculation with 2500 TSO. I totally underestimated how bad worm flu would feel. It’s hard not to give up. I feel like I’ve been hit by a truck! [55] [56]

More detail about possible side effects

The following study looked more closely at possible side effects after taking TSO.

Symptoms after Ingestion of Pig Whipworm Trichuris suis Eggs in a Randomized Placebo-Controlled Double-Blind Clinical Trial -- Full text | PDF

Avoiding side effects: the adaptation regimen

Anyone who is concerned about the possibility of side effects can start with a lower fortnightly dose and build up gradually to doses of 2,500.

Two doses of 500 TSO, followed by
two doses of 1,000 TSO, and then
six doses of 2,500 TSO.

I was nervous about TSO so I started with 500 then quickly moved up to 1000 and then 2500. I’ve had very few side effects. [57]

If someone who starts with doses of 2,500 finds that these cause diarrhoea or other side effects, they should switch to this adaptation regimen.

(See Dividing doses above for how to split larger doses into several smaller ones.)

If side effects are experienced at any stage of the adaptation regimen, that stage should be continued until the side effects have completely resolved.

If a patient is being cared for by a helminthic therapy-aware doctor, the latter may prescribe a short course of prednisone with a suitable taper. This treatment will usually allow the patient to take full doses of 2,500 TSO without experiencing any side effects.

Some individuals have found that even this adaptation regimen was too much for them, and they needed to start with microdoses.

I had to start with tiny doses (50+) because regular dosing made my AI symptoms very bad. [58]

Response to TSO

The conditions that appear to respond best to TSO are Crohn’s disease, ulcerative colitis, autism and lupus. [59] TSO can also be effective in food allergy, contact allergy, rheumatoid arthritis, multiple sclerosis and lichen planus (see more here), and it is worth trying for any autoimmune disease, or any condition with an inflammatory component.

Due to the considerable variation in how individuals respond to TSO, it is not possible to predict an accurate timeline that applies to all patients. However, it appears that around 80 percent of patients eventually respond positively to the treatment, although response and remission may take longer in the case of more severe or chronic conditions, or when individuals have been using a different helminth, such as NA, before commencing treatment with TSO. [60] [61] For this reason, anyone who is unsure which helminth species to use should ideally start with TSO, then add, or switch to, TTO, NA or HDC at a later date, if necessary. [62]

Most people notice the first improvements between the 4th full dose of 2,500 TSO (i.e., after 8 weeks) and the 6th full dose (after 12 weeks), and typically achieve remission after dose 10 (i.e., 20 weeks after commencing the treatment). However, response times do vary, and more than 10 full doses may be required in the case of patients with very severe or chronic disease. [63]

I saw improvement after the 4 doses, about 8 weeks. [64]

I am about 4 doses in and am just now feeling some improvement with UC symptoms. I have had some other changes like less joint pain, good sleep and less inflammation but just this past week I’d say I have fewer UC symptoms. [65]

It took me until about the 7th dose (14 weeks) to feel better. [66]

Experience gained from the use of TSO in thousands of patients over more than a decade, both in and outside clinical studies, suggests that the earlier in the disease process that treatment is initiated, the more rapidly it will work and the longer remission is likely to last once it has been achieved.

If patients stop treatment after remission is achieved, they don’t usually relapse again for between 1 and 3 years, and even longer periods of remission have been reported.

I have RRMS. I was in a clinical trial years ago and took TSO. I started with 5 brain lesions and 10 months later had 0. I felt great I was so pleased… Since then I have taken no meds. My MS has only shown one new lesion a few years ago. [67]

My brother used the TSO 2500 eggs twice a month for 18 months to cure his Crohn’s disease and it worked wonders for him. He stopped the TSO back in 2007, I think it was. (i.e., 15 years previously) [68]

Although this last quote refers to a cure, remission is all that can realistically be hoped for because no helminth can actually "cure" anything. Worms can only create the conditions conducive to remission, which can last for varying lengths of time.

When a patient does flare again, resuming dosing with TSO will result in a return to remission. It is recommended that those who do flare again should take periodic maintenance doses, the size and intervals between which can be established by personal experimentation.

I just take 500 ova (from a bottle of 2500) every two weeks. That’s all I need to maintain pain relief. [69]

I don't have to take it very often now. After 16+ years, I stay in remission for many months. I have several physical indicators that notify me to take a dose. I usually divide a bottle of 2500 and take it two weeks apart. Fall and winter is when I have a relapse so this is when I need to take a couple of doses. I estimate I take 2500 TSO approximately every yearly quarter, whenever I feel that my gut is not as happy, or see that my stool changes for a period of time indicating my gut is not happy, or my joints/body seems tight. (Edited from two posts: [70] [71])

I take 250 TSO twice a week. This schedule makes the benefits for my IBD more constant. [72]

A few patients may need long-term treatment with TSO, especially elderly individuals with a long history of autoimmune disease. One condition that may require long-term treatment is multiple sclerosis, and eczema is another, although this is dependent on how effectively the immune system can reset itself under the influence of the TSO. [73]

An even smaller number of patients may need to continue to take medication alongside TSO in the longterm.

I have had success only while taking TSO plus Humira. Humira alone does not make my Crohn's improve. Same with TSO. The combination seems to put me in clinical remission. [74]

One of the benefits of using a short-lived non-human helminth such as TSO or HDC is that, in comparison with the human-adapted helminths, NA and TTO, it is easier to experiment with the size and frequency of doses to find the optimal regimen for each individual.

Storage and survival of TSO

The doses of TSO supplied by Tanawisa are suspended in 15 ml of solution containing very small quantities of salts: 0.6 g of potassium chloride (KCl), 11g of sodium chloride (NaCl) and 16g of sodium phosphate monobasic dihydrate (NaH2PO4*2H2O) per 2L of distilled water. [75]

TSO is a very robust organism that can remain viable in soil for up to 9 years while exposed to all types of weather condition, from extremely cold to very hot. [76]

Each bottle of TSO carries an expiration date. [77]

After receipt, bottles should ideally be stored in a fridge, especially after they have been opened, because the cold will inhibit any bacterial growth. [78]

If stored in a refrigerator, TSO doses can remain viable for at least a couple of years, making it possible to take advantage of cheaper multiple packs, and to keep doses in reserve - something that is not possible with HDC (see Storage and survival of HDC) or NA (see Hookworm larvae storage and survival).

The excellent longevity of stored TSO, and the fact that it usually produces results more rapidly than TTO, make it ideal to be kept in reserve by users of NA for use in the event of the loss of their colony, or an interruption in benefits following the use of certain medicines and foods. (See the Human helminth care manual.)

I keep TSO for emergencies, such as, if I have to take antibiotics, or I accidentally ingest something that harms my (human) helminths. [79]

Where do TS live?

In humans, TS have been observed to settle predominantly in the caecum and the ascending and transverse sections of the colon, [80] as shown by the red text in the following representation.

mouth ➤ oesophagus ➤ stomach ➤ duodenum ➤ jejunum ➤ ileum ➤ caecum ➤ Ascending colon ➤ Transverse colon ➤ Descending colon ➤ rectum

Given that TS eventually settle in the caecum and colon, it might be assumed that administration of TSO via enema might be a viable alternative to the oral route, but it isn't. The eggs need the biochemical signal provided by the sudden increase in pH from the stomach (pH1) to the gut (pH8), which triggers hatching. [81]

The question of possible TS persistence

There is very little evidence to suggest that TSO might develop to adulthood and persist in humans, and some of the evidence that has appeared lacks credibility.

The first two reports, above, both concerned single individuals. In the first, patent infection was claimed on the basis of a biopsy and, in the second, by colonoscopy and the passage of unembryonated whipworm eggs in the subject’s faeces.

The subject in the second study had previously hosted the human whipworm, Trichuris trichiura (TT), which was assumed by those conducting the study to have been eradicated following the administration of mebendazole. However, the use of mebendazole to eradicate TT is not reliable unless 100mg of the drug is taken twice daily for at least 3-5 days (see Terminating a human whipworm infection) so, in spite of the bold claim by the researchers that they were the first to report a patent TS infection in a human volunteer undergoing TSO treatment, it is likely that the adult whipworms observed in this case were TT and not TS, and that the eggs were TTO and not TSO.

In the third study, above, only a single sample of Trichuris eggs showed merely a similarity to sequences of TS.

Doctors carrying out routine colonoscopy examinations on patients who are taking TSO have not reported finding any mature TS, and none have been observed in any of the clinical trials that have used this species, even though they included hundreds of patients. To read these studies, search the following page for "Trichuris suis".

Helminthic therapy research

Even after repeated dosing with TSO in clinical studies, no TS eggs were found in the stool samples of trial participants. [82] [83]

Nevertheless, it has been reported anecdotally by one researcher that individual TS might survive for as long as 6 weeks, and one TSO self-treater, who had never used any other whipworm species, claims to have seen a few adult worms, the last of which was noticed at approximately 12 weeks after her last (10th) dose of TSO. However, these worms were never confirmed to be TS, and no adverse effects were reported by the patient.

Another self-treater who is taking fortnightly doses of 2500 TSO, and has never used any other whipworm species, observed a worm in their stool on three occasions. These were described as being white and around 3 cm in length with one thick end and one thin - characteristics suggestive of adult whipworms. [84]

In a further case, the mother of a four year old girl who was taking TSO, but had never taken TTO, has reported seeing an intact whipworm in a potty used by her daughter. This specimen's thicker portion was a little over 1/4 inch long and the thinner section approximately 3/4 inch long. A good image of this worm had been captured by the mother and was seen by one of our editors, who confirmed that it did indeed appear to be a not-yet-fully-mature whipworm.

Obtaining TSO

The only manufacturer and supplier of TSO is Tanawisa. Shipments typically reach their destination within 3 days of ordering.

The strain of TSO supplied by Tanawisa was originally sourced from the United States Department of Agriculture farms in Baltimore, Maryland, and was used in the studies by Weinstock et al, and in all other clinical trials in humans. [85]

Caring for TSO

TSO are much less susceptible to ingested substances than the human hookworm, NA. And TSO also require replacement every couple of weeks, so their longevity is not the issue that it is for human helminths. They do, however, need to be as healthy as possible during their short lives in order to deliver the benefits of which they are capable.

Humans today consume a countless number of products and substances, such that it is not possible to list every single food, supplement and chemical and say whether they may, or may not, have some degree of adverse effect on this species, but the most significant potential threats to TSO are listed in this section, along with a few other substances about which TSO self-treaters have asked most often.

Using this section

* Rather than scanning this section visually, use the search function on your device:

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Mobile - "Find in page" in the drop-down menu from the three dots icon

* If no search results are found (and your spelling is correct) the substance is more likely to be safe than unsafe for TSO. However it is worth also checking whether any subtance not mentioned here is mentioned in the more comprehensive Human helminth care manual. Although TSO are much more robust than human helminths, details in the HHCM can provide additional insight into the possibility of an effect on TSO.

* The following classification codes are intended as a general guide only, because the effects of a substance can vary considerably depending on factors such as quantity, concentration, and, in the case of herbal extracts, the part of the plant used. Even the method of extraction can make a difference, and, in the case of foods, perhaps the method, temperature and duration of any cooking, [86] so it is important to read the details for each item rather than rely solely on the codes.

❌ Will or may kill, or cause the loss of, TSO.

⚡May cause harm to TSO in some people.

➿ May cause a temporary reduction in the benefits from TSO.

❓Insufficient evidence exists to support a judgement about possible effects.

✅ Safe, or likely to be safe, for TSO.

Important notes

* TS and their ova, TSO, are very robust organisms, and most foods, drugs and other substances are perfectly safe for use while hosting them, including normal dietary amounts of the vast majority of foods, spices and herbs.

* Medicinal quantities of concentrates, extracts or tinctures, especially of certain herbs, are more likely to have an adverse effect on TSO than the plants from which they are derived.

* The extent to which a food or other substance might have an adverse effect on TSO varies between individual hosts, depending on their immune system’s genetically determined tolerance for worms. This dictates the underlying level of duress that the worms are already under before they have to deal with ingested substances.

* Substances that are applied to the skin topically in small quantities are unlikely to cause harm to TSO, even if they are known to be a risk when ingested.

* Substances listed elsewhere on the internet as being "antiparasitic" may have no effect whatsoever on TSO. Helminths are only one of many different types of organism that are categorised as "parasites", among which there is a very wide range of responses to substances claiming to be antiparasitic. What kills one type of parasite may not even harm another. Even substances that have shown an anthelmintic effect in test tube studies do not necessarily have an adverse affect on worms being hosted by humans. [87]

Anthelmintics

Pharmaceutical anthelmintics

Not all anthelmintic drugs and anthelmintic food substances will kill TSO. Some may only have a mild, or moderately adverse effect, especially some of the anthelmintic drugs recommended as being lethal to different helminth species. However there is a potential for any anthelmintic substance to at least reduce the therapeutic benefits of TSO. The following are therefore best avoided if possible.

❌ Abamectin

❌ Albendazole (Albenza, Valbazen, Zentel, etc.)

❌ Aminoacetonitrile derivatives

❌ Arecoline (Arecaline, Arecholine, Arecolin, Arecoline base, Arekolin, Methylarecaidin.)

❌ Artemisinin (Artemisinine, qinghaosu)

❌ Bephenium hydroxynaphthoate (Alcopar, Alcopara, Befenium, Debefenium, Francin, Nemex). This is an anthelmintic agent once used to treat hookworm and roundworm infections.

❌ Diethylcarbamazine (DEC, Hetrazan, Carbilazine, Caricide, Cypip, Ethodryl, Notézine, Spatonin, Filaribits, Banocide Forte and Eofil)

❌ Emodepside (Monepantel)

❌ Fenbendazole

❌ Flubendazole (Flutelmium, Flubenol, Biovermin, Flumoxal.)

❌ Ivermectin (Stromectol, Soolantra, Sklice, etc.)

❌ Levamisole (Decaris, Ergamisol) is an antihelmintic drug approved for use in veterinary medicine in the United States. It was once used in the treatment of rheumatoid arthritis but proved too dangerous.

❌ Mebendazole (MBZ, Vermox, Ovex). Mebendazole will eradicate TSO almost instantly. [88]

❌ Metronidazole (Flagyl)

❌ Niclosamide (Niclocide, Fenasal, Phenasal, etc.)

❌ Nitazoxanide (Alinia, Nitaxide) is a broad-spectrum antiparasitic and broad-spectrum antiviral drug used to treat various helminthic, protozoal and viral infections. It has demonstrated activity against tapeworms, [89] so may also have an adverse effect on hookworms and whipworms.

❌ Odanacatib (codenamed MK-0822) is an investigational treatment for osteoporosis and bone metastasis developed by Merck & Co., and possibly available for clinical use from 2016. Unfortunately, this drug has been shown to kill the hookworm, Ancylostoma ceylanicum, in hamsters, decreasing worm burdens by 73%. [90] Consequently, it is likely to be trialled as a potential alternative to albendazole and may have an adverse effect on the human hookworm as well as other helminths, so should be avoided by helminth self-treaters.

❌ Oxamniquine (e.g., Vansil)

❌ Oxyclozanide

❌ Penicillium cluniae (a fungus species of the genus of Penicillium which produces the antinematodal and antiparasitic agents paraherquamide B, paraherquamide C, paraherquamide D, paraherquamide E, paraherquamide F, paraherquamide G, paraherquamide H.)

❌ Piperazine (piperazine hydrate and piperazine citrate are anthelmintic drugs that kill 60-70% of adult roundworms) and piperazine's many derivatives.

❌ n.wikipedia.org/wiki/Praziquantel Praziquantel (Biltricide etc.)

❌ Pyrantel pamoate (Pin-X, Combantrin, etc.)

❌ Pyrvinium (Vanquin, viprynium). This anthelmintic was previously used to treat pinworm (Enterobius vermicularis) infections, but has been largely replaced by other anthelmintics, e.g., mebendazole or pyrantel pamoate.

❌ Salicylanilide, Spiroindoles (e.g. derquantel)

❌ Tiabendazole (thiabendazole, TBZ, Mintezol, Tresaderm, Arbotect, etc.)

❌ Triclabendazole (Fasinex, Egaten, etc.).

Natural anthelmintics

The following natural anthelmintic substances have been suggested as being possibly harmful to TSO [91] but their actual effects on helminths are variable. The details below offer nuance about the possible risks.

❓ American wormseed (Dysphania ambrosioides). This was formerly known as Chenopodium ambrosioides and Jesuit's tea, Mexican-tea, payqu (paico), epazote, mastruz and herba sanctæ Mariæ, but the variety, Chenopodium ambrosioides var. anthelminticum, is now accepted as Dysphania anthelmintica.

❓ Berberine is an amebicide which, in concentrated form, has been shown to kill various parasites such as tapeworms and giardia and to have anti adhesive effects which prevent pathogens from adhering to intestinal mucosal cells. One hookworm host who took one gram of berberine three times a day has reported being pretty sure that this killed his worms. [92] However, there have been no reports about its effects on TSO.

❓Bitter melon (Momordica charantia) Also known as Momordica chinensis, bitter melon, goya, karela, ampalaya, bitter apple, bitter gourd, bitter squash and balsam-pear. This cucumber-shaped vegetable is found in Asian markets, and aqueous extracts of its leaves and seeds have both been shown to have a dose-dependent adverse effect on one type of adult non-therapeutic helminth (Strongyloides) in test tube studies. [93] Both its fruit and seeds have been, and still are, used in a number of countries to treat pinworm infections, and for expelling parasites generally. However, the quantities of fruit and seeds that are quoted as being necessary in order to eradicate worms are rather large, for example two whole melons each day for seven to ten days, repeated after two months. It is therefore unlikely that normal dietary amounts of bitter melon fruit will adversely affect therapeutic helminths, and one host of the more vulnerable species, NA, has reported that bitter melon is a regular part of her diet, but has never adversely affected her worms. [94]

❌ Black cumin (nigella sativa). Also known as blackseed, black seed, black caraway, fennel-flower, nutmeg flower, Roman coriander, kalonji and 'Love in the Mist'. Extracts of this herb have shown antifungal effects [95] against different strains of Candida albicans, but it has also been used as an anthelmintic since ancient times. In India, today, nigella seeds are combined with various purgatives to help kill and expel intestinal parasites, and they have a synergistic effect with pharmaceutical anthelmintics. [96]

❓ Black walnut (Juglans nigra). Also known as eastern black walnut. This nut has been claimed to be one of the best overall dewormers for humans, killing both the adult and developmental stages of at least 100 parasites. However, according to the American Cancer Society, available scientific evidence does not support claims that the hulls of the black walnut remove intestinal parasites. Although this nut has a strong flavour, it is actually quite rare, as its shell is hard and difficult to remove. It is therefore only likely to be encountered in expensive baked goods. Most commercially available walnuts are hybrids of the ✅ English walnut.

❓ Clove (Syzygium aromaticum/Eugenia caryophyllus). Clove oil, which was used traditionally to kill intestinal worms and is claimed to anesthetize fish, contains several powerful antimicrobial agents. While one of these, eugenol, is claimed to be anthelmintic, its use didn't produce any loss of benefit in one hookworm host who applied it liberally to a dry socket following a difficult tooth extraction, and this was in spite of swallowing and breathing eugenol and a related compound called guaiacol.

❓ Elecampane (Inula helenium), also called horse-heal or elfdock. While this is reportedly to be found in absinthe, there is no evidence that it might be harmful to TSO.

❓ Hagenia (Hagenia abyssinica). Also known as African redwood, brayera, cusso, hagenia, and kousso. Hagenia has been used as a treatment for the pork tapeworm (Taenia solium), but is often only partially effective in this case.

❌ Male fern (Dryopteris filix mas). Also once known as worm fern. The rhizomes and young shoots (fiddleheads) of the male fern have antiparasitic properties and the root has been used to treat tapeworms. However, this herb is seldom used today due to its side effects (e.g. headaches and nausea) and because large doses are extremely poisonous and may induce liver damage. The North American equivalent of the male fern is the evergreen marginal shield-fern (Dryopteris marginalis).

❌ Mimosa pudica Also known as shy plant, sensitive plant, sleepy plant, action plant, touch-me-not, and shameplant, this popular houseplant is a tropical fern, whose leaves close rapidly when touched. Aqueous methanol extracts of the leaves of this plant showed a similar ability as the anthelmintic drug, levamisole, to inactivate larvae of the helminth, Strongyloides stercoralis. [97] While there have been no reports to date of this plant having a harmful effect on any of the therapeutic helminths, it has been used extensively as an anti-parasitic agent in traditional and Ayurvedic medicine, so clearly has significant potential as an anthelmintic. Since the main mode of action of TSO is based on the release of cytokines, proteins and proteases from the eggs, Mimosa pudica should not block this process completely, but may slow down TSO’s beneficial effect. If someone wishes to combine treatment with TSO and Mimosa pudica, it may be best to take the TSO weekly rather than every fortnight. [98]

✅ Monarda. Also known as bergamot, bee balm, horsemint and oswego tea, this genus of flowering plants in the mint family has a long history of use in traditional forms of healing, probably due to its strong antiseptic properties, but there is no evidence that it might harm TSO.

❓ Moringa (Moringa oleifera, also known as drumstick tree, horseradish tree, ben oil tree and benzoil tree) Although described as a “natural anthelmintic”, moringa has been taken by two helminth self-treaters with no apparent adverse effect on their hookworms, which are less robust than TSO. The first takes a 500 mg capsule of 10 to 1 extract (from 5000 mg of Moringa olifeira) twice a week, [99] while the second grows and harvests her own moringa. [100] Whatever anthelmintic properties moringa might have may depend on the part of the plant used.

❌ Neem (Azadirachta indica). Also known as margosa, nimtree and Indian lilac. Ayurvedic medicine holds that Neem is the best herb for treating worms and other parasites and that a simple decoction of Neem leaves can kill all parasites present in the intestines. Neem extract has also been shown to be more effective against rodent helminths than standard chemotherapy with albendazole or mebendazole.

❌ Olive leaf extract (Olea europaea). Known as 'nature's antibiotic', this extract contains a component called oleuropein that is able to degrade pathological microorganisms of all kinds, and inhibit or kill many types of intestinal parasites including flatworms, hookworms, roundworms and tapeworms. Two hookworm self-treaters have reported losing their colonies after taking this, but the exact effect on TSO has not yet been described.

❓ Pau d’arco. Also known as lapacho, red lapacho or taheebo. Pau d'arco is a tea made from the inner bark of Handroanthus impetiginosus (Pink Ipê), which is claimed to have antiparasitic effects. Its main active ingredients are lapachol, quercetin and other flavonoids. Having expectorant properties, it is used as a herbal remedy for colds, flu and smoker's cough. However, lapachol is rather toxic and is more often used topically, for example as as antibacterial or pesticide. There have been no reports from helminthic therapy self-treaters to suggest what effect, if any, drinking pau d'arco might have on TSO or other therapeutic helminths.

❌ Peganum harmala Also known as wild rue, Syrian rue, African rue, esfand or espand, and harmel, this plant was used traditionally as an anthelmintic.

❌ Plumeria rubra (Sometimes having been referred to as either P. acutifolia or P. acuminata.) The USDA Forestry Service lists Plumeria rubra as a poisonous plant and warns against touching or eating any part of it. However, due to it having antibiotic, antifungal, antiviral, analgesic, antispasmodic, and hypoglycemic properties, it has long been used in traditional medicine, including as a laxative and purgative. Its inclusion in lists of anthelmintics is likely due to its laxative and purgative effects rather than to any direct effect on helminths, themselves.

✅ Pumpkin and ⚡ Pumpkin seeds (Cucurbita species). Pumpkin is also referred to as squash or gourd, depending on species, variety and local parlance. Eating the flesh of the pumpkin/squash/gourd is unlikely to have an adverse effect on any helminth. However, ⚡ Pumpkin seeds contain an antiparasitic compound called curcurbitacin and they were used traditionally as a remedy for tapeworms and roundworms. The effect of the seeds is likely to be dose-dependent, and large amounts are recommend by herbalists for deworming, e,g., up to 25 ounces for adults. Some hosts of the human hookworm, NA, which is much more susceptible to harm than TSO, have reported no adverse effect on their colony after eating pumpkin seeds, [101] [102] while other hookworm hosts have experienced either a temporary return of disease symptoms or even a loss of their colony. For example one found that eating a daily salad for a week with a mixed seed/nut topping containing pumpkin seeds killed her entire colony. [103] Another NA host has reported that taking 1000 mg of ⚡ pumpkin seed oil daily for 2 months significantly reduced the fecundity of his NA, resulting in incubations producing only a handful of L3 larvae after having previously always yielded hundreds of larvae per incubation over a 7 year period. [104] Since this individual is not treating a disease, but only acting as a reservoir donor, it is not known whether this amount of pumpkin seed oil might affect disease remission. The exact extent of any effect on TSO of eating pumpkin seeds is still unknown.

❓ Ruta graveolens Also known as rue, common rue or herb-of-grace, it is not clear how much of threat this ornamental plant and culinary herb presents for TSO, although its relative,❓Ruta chalepensis (fringed rue) has shown anthelmintic activity against gastrointestinal nematodes in dairy ewes. [105]

❓ Spondias mombin Referred to as java plumb, and also known by many other names, an active compound isolated from an extract of this plant has shown some anthelmintic activity, [106] but it is not known to what extent it might harm TSO.

❌ Tansy (Tanacetum vulgare), also known as common tansy, cow bitter, bitter buttons and golden buttons, is highly toxic to intestinal parasites and, for centuries, tansy tea has been prescribed by herbalists to expel worms. One study found that both the crude hydroalcoholic extract of T. Vulgare, and its essential oils, possess significant activity against adult S. mansoni worms, and the activity of the essential oils may be related, at least in part, to monoterpene thujones, which were detected as major constituents of the essential oils. [107]

❌ Wormwood (Artemisia Absinthium). Also known as common wormwood, green ginger or grand wormwood, this herb was used traditionally as an anthelmintic. Other members of the genus, artemisia, that were traditionally used as anthelmintics include white wormwood (Artemisia herba-alba), Eurasian wormwood (Artemisia cina) commonly known as santonica, Levant wormseed and wormseed, and Russian wormwood (Artemisia vestita) also known as Buer, Chamariya, Drubsha, Ganga Tulsi, Kubsha, Kundiyaa, Kundja and Seski. [108]

Antibiotics

Most antibiotics are well tolerated by TSO, for example, ✅ Penicillin and ✅ Amoxicillin [109] but a few antibiotics can reduce this organism’s effectiveness, with the result that the beneficial results from TSO may be delayed.

❌ Ciprofloxacin can at least temporarily reduce TSO’s beneficial effects. [110] [111]

➿ Metronidazole (Flagyl, and others) can inhibit the beneficial effects of TSO. [112] However, this effect is only temporary, and more a case of putting the therapy briefly on hold rather than causing a permanent setback. [113]

➿ Vancomycin can somewhat reduce the effectiveness of TSO. [114]

Antidepressants

According to a 2018 Nature article, [115] some SSRIs (setraline, paroxetine, and chlorpromazine) have such a powerful anthelmintic effect that the authors suggested these drugs could be used clinically as dewormers. But several self-treaters who are using the human helminths, NA and TTO, are taking SSRIs alongside the worms without any apparent problem.

✅ Sertraline (Sold under a very large number of trade names, including Zoloft. [116]) This antidepressant of the selective serotonin reuptake inhibitor (SSRI) class, has shown anthelmintic effects against several worms. For example, it kills C. elegans at multiple life stages and acts rapidly to inhibit its feeding within minutes of exposure. It also decreases motility of adult Trichuris muris whipworms, prevents hatching and development of Ancylostoma caninum hookworms and kills Schistosoma mansoni flatworms. The evidence suggests that it may act on novel targets to kill worms. [117] However, “Sertraline is almost completely absorbed from the intestine and then metabolized by the liver. The effect usually occurs after a period of use of about two weeks, but it can take up to a month or longer for the sertraline effect to fully develop. Due to the fact that trichuris suis burrows into the crypts of the intestine immediately after hatching and due to repeated administration at relatively short intervals, I see no reason why sertraline would harm TSO.” [118]

❓ Paroxetine (Trade names include Aropax, Brisdelle, Deroxat, Paxil, Pexeva, Paxtine, Paxetin, Paroxat, Paraxyl, Sereupin, and Seroxat.) This antidepressant has shown anthelmintic effects against several worms. It kills C. elegans at multiple life stages and acts rapidly to inhibit its feeding within minutes of exposure. It also decreases motility of adult Trichuris muris whipworms, prevents hatching and development of Ancylostoma caninum hookworms and kills Schistosoma mansoni flatworms. The evidence suggests that it may act on novel targets to kill worms. [119]

For more about the experience of NA and TTO hosts who have taken antidepressants, see, The human helminth care manual: Antidepressants.

Antifungals

Most antifungals will not harm TSO, but they may slow down their mode of action. [120]

Antimalarials

✅ Hydroxychloroquine (Plaquenil, etc.) This is safe to use while taking TSO. [121]

Antipsychotics

❌ Chlorpromazine (Thorazine and Largactil, etc.) This antipsychotic medication has shown anthelmintic effects against several worms. It kills C. elegans at multiple life stages and acts rapidly to inhibit its feeding within minutes of exposure. It also decreases motility of adult Trichuris muris whipworms, prevents hatching and development of Ancylostoma caninum hookworms and kills Schistosoma mansoni flatworms. The evidence suggests that it may act on novel targets to kill worms. [122]

❓ Olanzapine (Zyprexa and numerous other names) is derived from the anthelmintic compound, piperazine, so may have a theoretical minor effect on TSO, but, due to this organism being given every other week and never reaching maturity, the drug will only be able to slow TSO down a little, rather than inhibiting it.

Foods

⚡ Coconut products should be treated with caution by TSO users, especially coconut fibre found in dried or ground coconut flesh (desiccated coconut/coconut flour) which has long been used to expel intestinal worms, and becomes more effective as the quantity increases. [123] However, coconut may not be a problem if it is consumed in small quantities and not taken at the same time as, or within a few hours of, a dose of TSO. [124]

The partner of one TSO user has reported:

We know that coconut affects her TSO (2500 every two weeks) from a past mistake with coconut milk. [125]

Some CBD oils for vaping are suspended in coconut oil. However, most of these are only a 3% suspension, so will probably be safe for use while hosting TSO.
Coconut sugar should not carry the same degree of risk as other coconut products because, whereas coconut milk, oil and flour are all obtained from the flesh of mature coconuts, and coconut water is also from inside the fleshy part of the coconut, coconut sugar comes from the sap of coconut palm flower buds and consists largely of sugars.
The seasoning sauce, Coconut Aminos, is also made from coconut tree sap, and at least one host of NA (a much less robust helminth than TSO) has used Coconut Aminos regularly without issue. [126]

❓Pineapple. One TSO user has observed that, if he eats a "good quantity" of fresh pineapple on the day he takes TSO, or the day following, he does not feel the same positive immune modulation that he usually experiences at that time. [127] However, eating pineapple at any other time in the dosing cycle does not appear to have this effect, and he concedes that this observation was made on only a few occasions, so it may be a case of correlation rather than causation. If pineapple did cause this effect, it might have been due to bromelain, the digestive enzyme found in pineapple, which is known to have an impact on intestinal worms.

Herbs and medicinal plants

✅ Ashwagandha (Withania somnifera). Also known as Indian ginseng, poison gooseberry, and winter cherry. This will not harm TSO, but see the list of concerns and contraindications regarding Ashwagandha, itself, in this Facebook post.)

Isomyristicin and bergaptenix are two phytochemical compounds isolated from the Bhutanese medicinal plants, Corydalis crispa and Pleurospermum amabile, which have shown significant anthelmintic activity against the helminths, Schistosoma mansoni and Trichuris muris. In concentrated form, they may therefore be harmful to other whipworms and possibly also other worm species. [128] However, it should be noted that myristicin (the parent chemical from which isomyristicin is derived) and bergapten are both found in very small quantities in the vegetables, herbs and fruits consumed by humans on a daily basis, e.g., parsley, celery, lemons, figs, carrots, grape juice, nutmeg and dill, but the risk of an anthelmintic effect from this very limited dietary intake is negligible. [129] These chemicals are also found in ⚡ Earl Grey tea, which is flavoured with bergamot oil, and one hookworm host has reported that she experienced a return of symptoms of her disease (POTS) after drinking this brew. However, many other NA hosts drink this tea without any problem, and it is thought unlikely that it presents any threat to TSO.

❌ Biocidin is a proprietary herbal blend that includes oregano oil and black walnut, both of which are known to have anthelmintic effects. See the separate entries for each of these two herbs.

Spices and cullinary herbs

✅ Turmeric and ❓curcumin (Curcuma longa). Turmeric, which is also known as tumeric, should not harm TSO when eaten in food in its natural, whole form, which only contains 3% of the active ingredient, curcumin, [130] or when it is taken in capsules.
There is more chance of TSO being harmed, or their beneficial effects being restricted when curcumin is extracted from the turmeric and taken in medicinal quantities. It has been reported that 300 mg of curcumin extract has killed some types of parasites in test tube and animal studies.
As with other substances that can affect helminths, the effect of curcumin may depend to some extent on the user's genetically determined level of tolerance for helminths, as well as on the form of curcumin used.
Nano-emulsified curcumin appears to be more effective, therapeutically, [131] so may also have an increased detrimental impact on helminths. Another high-potency form of curcumin is BCM-95, which has been shown to be 6.93 times more bioavailable than normal curcumin, but one TSO user who has taken this concentrated form has not observed any noticeable impact on ther worms. [132] The beneficial effect of curcumin can be increased 5- to 10-fold by adding ascorbic acid (vitamin C) [133] so taking this vitamin along with curcumin might make it possible to use curcumin therapeutically in much smaller doses (ascorbic acid does not harm helminths), although this vitamin may increase curcumin's adverse effect on helminths if the quantity of the spice is not reduced proportionately. It may be that any adverse effect of curcumin on TSO might be mitigated to some extent if curcumin is avoided on the day that the TSO is taken.

✅ Oregano and ❌ oregano oil (Origanum vulgare). Oregano leaves should not harm TSO when eaten in dietary quantities, however, oregano oil, which contains isomeric phenols (primarily carvacrol but also including thymol and limonene), can destroy a number of bacteria, fungi and viruses in dilutions as low as 1/50,000, and is also antiparasitic. It is reported to be effective against protozoan parasites in particular as well as roundworm larvae, and somewhat effective against tapeworms. In one study [134], 57 per cent of adults with intestinal parasites who were treated with 600 mg of oregano oil daily for six weeks experienced total eradication of their parasites. Several hosts of therapeutic helminths have reported adverse effects on their worms after ingesting oregano oil and, in at least two cases, it has resulted in a total loss of human helminths. However, one subject, who took oil of wild oregano sublingually twice each day for 2 weeks had a stool test sometime after this that was positive for hookworms, so perhaps either the wild form of the herb, or the sublingual route, helped reduce the effect on the worms in this case. Some foods, particularly soft cheeses, may be coated with an antimicrobial film incorporating oregano oil to increase their lifespan, but the amount of oregano involved in this application is unlikely to be a threat to helminths.

Medical procedures

✅ Colonoscopy prep using products such as polyethylene glycol (PEG), Macrogol, Colyte, Picosalax, Bisacodyl, phospho soda, sodium picosulfate, or sodium phosphate and/or magnesium citrate, is known not to have any adverse effect on TSO because subjects in the early TSO clinical trials all had colonoscopies and none of these patients lost their TSO. (Private message from one of the research team.)

❓Colon cleansing Until Trichuris suis hatch and begin to embed themselves in the colonic mucosa between 10 and 14 days after ingestion, it is possible that TSO might be flushed away by a colon cleanse. [135] This would be especially likely if the fluid used contained something to which whipworms are vulnerable. However, there have been no reports of this happening.

Miscellaneous

✅ Coffee enema Although there is a small theoretical possibility of harm to TSO from a laxative effect of coffee enemas, this is not considered to be of any real concern.

❌ Damage during transit. It is possible for a dose of TSO to be damaged by freezing during transit. However, this had only ever been experienced by one or two users during the first two decades of TSO use.

❓Glucagon-like peptide-1 receptor agonists, also known as GLP-1 receptor agonists (GLP-1-RA) or incretin mimetics, e.g., exenatide (Byetta, Bydureon), liraglutide (Victoza, Saxenda), lixisenatide (Lyxumia, Adlyxin), albiglutide (Tanzeum), dulaglutide (Trulicity), semaglutide (Ozempic, Rybelsus, Wegovy) and tirzepatide (Mounjaro). This type of drug, which is used to treat diabetes and obesity, has shown anthelmintic effects and has been proposed as a potential anthelmintic agent against Trichuris trichiura. [136] However, no reports of any adverse effects have been posted by helminth hosts.

✅ Hydrogen peroxide (H2O2). While H2O2 appears to be able to kill some helminths in a petri dish, it needs to be in direct contact with the organism to do this. And, being very highly reactive, it dissipates extremely quickly, so, if ingested, there is likely to be little left by the time it reaches the stomach. Since any nebulised H2O2 will be confined to the airway and lungs, with very little reaching the blood, its only direct contact with TSO - which only travel along the digestive tract - would be when they pass very briefly through the mouth at the start of their journey, at which point the larvae are very well protected inside the egg. Any H2O2 added to bath water will also not come into contact with TSO at all. H2O2 is therefore not seen as being a threat to TSO when used as a therapy.

✅ Ketamine There have been no reports to suggest that ketamine might be harmful to helminths, but the drug itself can cause stomach pain. For more information about this, see this article.

✅ Ozone. Ozone therapy is used as an alternative treatment for various diseases in humans but is still controversial. Ozone is also used to kill microorganisms, in some instances being employed in place of chlorine as a bactericide. It is also used to eradicate water borne parasites such as Giardia lamblia and Cryptosporidium, and to kill insects in stored grain. So there would appear to be a possibility of ozone having at least some adverse effect on human helminths, particularly the blood-feeding NA, but there have been no reports to suggest even this, and the amount of H2O that might reach TS would be negligible. It had been suggested that ozone might be a possible threat to TS when used as a rectal insufflation, but Tanawisa have confirmed that not even this application would be a risk for TS. [137]

✅ Promethazine (Phenergan, Promethegan, Romergan, Fargan, Farganesse, Prothiazine, Avomine, Atosil, Receptozine, Lergigan, and, in the UK, Sominex). This drug does not appear to kill helminths, whether taken orally or by intramuscular injection. There is a possibility that it might have some adverse effect on NA in some individuals, but it is not a threat to TSO.

✅ Pulsed electromagnetic field (PEMF) therapy This will not harm TSO.

❓ Rife machines. These devices are claimed to be capable of killing or "devitalizing" worms when set to 2,400 Hz. Assuming that they are able to do what is claimed (and this is a contentious issue) it would seem sensible, if using these machines, to avoid the 2,400 Hz frequency, and any others that are claimed to affect helminths.

✅ Vitamin C There are no risks to TSO from vitamin C other than the possibility of diarrhoea caused by taking excessive oral doses, which could theoretically wash out some of the ova/larvae, but only before they have attached to the intestinal lining.