Worm therapy might be the missing link for gut health. This is because most of our hunter-gatherer ancestors were colonized by worms, and these worms appear to have an anti-inflammatory effect. Modern day, we are missing these worms and their anti-inflammatory benefits. Today I speak with Duke researcher Dr. William Parker. We discuss how worm therapy might be able to help IBS, IBD, depression, anxiety, allergy, and even autism.
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Are Worms the Next Probiotic? – with Duke Researcher Dr. William Parker
Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am here today with Dr. William Parker, and we are going to talk about helminths, which is the polite medical term for worms, which have some surprising health benefits. So before you freak out and stop listening, let’s bring on Dr. Parker and dive into what is, I think, actually a fascinating topic.
William, thanks for being on the show today.
Dr. William Parker: Thanks very much, Michael. It’s a pleasure to be here.
DrMR: Can you tell people a little bit about your background, your research? You’re kind of like “the guy” in this area of research, and I’m very happy to be picking your brain. Tell people a little bit about how you go into this and what you’re currently doing in terms of being on the forefront of the research with helminth therapy.
DrWP: Thanks. I’m definitely “the guy” when it comes to understanding the effects of helminths. And by helminths, we don’t mean any worms. So an earthworm, for example, is not… The kind of worm that you go fishing with or a grub worm. And a lot of people don’t—or a meal worm which is actually a good source of sustainable protein. Those are not the kind of worms we’re talking about.
We’re talking about worms that actually live inside our bodies. And especially we’re interested in the ones that live in the gastrointestinal tract.
DrMR: And these are often considered parasites by many? But that’s shifting in terms of maybe they’re not parasites and maybe they’re like bacteria that have a beneficial function for the host. Correct?
DrWP: Right. Right. I’ll get back to your original question about how we got interested in this in the background. But, yes, absolutely. So if you look back in say late 1800s, they figured out that bacteria were killing people, infectious disease. So they immediately assume all bacteria are bad. And then immunology, the field in general has a history of being based on infectious disease.
So it wasn’t until recently in the 1990s that we figured out, oh my goodness, the immune system actually spends most of its energy supporting the growth of these beneficial bacteria.
DrMR: Good point.
What are Helminths?
DrWP: Yeah, it sometimes takes a long time for… And when we first proposed that, we got a tremendous amount of—we received a lot of ridicule, quite a bit of ridicule. And that’s just how science works. It takes a while to change. But now, fortunately, things have changed around. And we’re in the same transition with these intestinal worms, but it’s just at the beginning.
If you look at any textbook right now in biology, you will see that 100% of the worms, the helminths, that live in our body are classified officially as parasites even though it’s been proven beyond doubt that not all of them are harmful. So by definition, they’re not a parasite.
DrMR: Right. And you make such a good point which is there was this age of antibiotics, and rightfully so, that achieved quite a bit for medical science. But we kind of threw the baby out with the bathwater, and now the pendulum has really swung in the other direction with bacteria. And many people really try to avoid antibiotics as much as they can and are very concerned with trying to ensure they have a healthy population of bacteria in their guts.
And so, it’s a great analogy looking at the way helminths or worms may kind of be paralleling that. We’re just a little bit farther behind the eight ball with the research regarding worms.
But I interrupted you, so let me shift this back to your background and how you’re currently involved in the field.
DrWP: Right. So my background is in biophysics, a type of specialized biochemistry where we study the molecular interactions between different molecules and how they fit together. I was hired at Duke University to look at parts of the immune system that literally people had not looked at since World War I. We were looking at blood group antibodies, some very basic parts of the immune system. And nobody had been looking at them because there’s no disease associated with them.
If you look at a very basic, fundamental part of the immune system, you don’t see a lot of diseases there because when that part of the system breaks, usually—especially if it’s genetic—people don’t survive to birth. If there’s not a lot of disease, you don’t get to study it.
But we were looking at something interesting which is a separate story, but very interesting, called xenotransplantation, trying to use genetically altered pigs to make organs for human beings who need an organ because there’s an organ shortage.
So the bottom line, a long story short, is we found ourselves studying these components of the immune system which nobody had looked at for 100 years. We applied modern techniques to them, and one thing led to another. We’re trying to track down why is there so much inflammatory disease, and it led us to the worms.
Current Research on Worm Therapy
DrMR: Gotcha. Are you participating in clinical trials at Duke now with worms? I know you can’t do this unless you’re part of a research study, as I understand it. Is that something that you’re currently participating in at the moment?
DrWP: So there’s two issues. There’s a lot of people that have been looking at worms and their effect on human health, their effect on inflammatory diseases. A lot of those people are studying specific molecules and trying to make drugs. So I’m not an expert on that. Our view on it is that the natural worm actually will probably work better because the worm is so complicated. It’s hard to recapitulate that complexity using a simple drug that you can take in a pill.
DrMR: I agree.
DrWP: There’s other individuals who are experts on certain worms, specific worms that they’ve been looking at. My expertise is in general on studying people who are not participating in clinical trials but are just trying worms on their own. There’s people that sell worms. They’re produced legally in different parts of the world, not in the United States, but in different parts of the world. And people can buy them and use them.
That’s what we do. We work with sociologists and study… Janet Wilson has helped us tremendously. She’s a professional sociologist that’s looking at how the worms affect people. And of course, sociological studies, they’re different than, say, clinical trials. To your point, we are working on getting clinical trials going here at Duke. But at the present time, there are no clinical trials in the United States at all dealing with helminths.
Helminths and Autoimmune Conditions
DrMR: I think your specific niche area of expertise is actually perfect, because that’s pretty much what I’m after, which is how to maybe help advise people or what reflections can we pull from people’s experimentation. Let me ask you this as kind of a lead-in because there’s many directions I want to go.
DrMR: Conditions that this can help. Certain things come up. Inflammatory bowel disease, I’ve read of a few trials with IBD. Curious about IBS. Mark Davis, who’s a naturopathic physician who came on the podcast and is kind of an expert in fecal microbial transplant therapy. He commented that it’s his opinion that helminth therapy can essentially halt MS. Another study’s been done on autism that was interesting.
So what conditions does this appear to maybe help most and/or maybe help least from your observation?
DrWP: The conditions that—and there’s a caveat and I’ll throw that in in a minute. But the conditions that it helps most tend to be especially autoimmune conditions that are relapsing and remitting. So if it’s episodic. In other words, if you have sort of attacks. It’s an autoimmune disease that’s not persistent, but you have some bad days and some good days.
DrWP: Especially, like I said if it’s episodic or characterized by having an attack. Those seem to be very profoundly affected.
And I think your previous guest Mark Davis is correct that the data with multiple sclerosis are extremely compelling. Now, based on our studies, the helminths work very well for the most common type of multiple sclerosis, which is the kind that’s characterized by relapses.
They don’t work too well with what’s called progressive multiple sclerosis, the kind that’s persistent. And we see the same thing with allergies. If someone, say for example, has a peanut allergy or a seasonal allergy, that’s going to be a periodic thing. It’s not going to be all the time. The helminths seem to help tremendously with those.
Now, they don’t seem to block completely the allergies, but they seem to greatly attenuate. And sometimes, they can absolutely just eliminate the allergy. In fact, the first treatment ever reported I think in 1978 by a scientist named John [Turtan] was he used some hookworms, and his seasonal allergies went away. He published that paper in the Lancet. It’s not new. The very compelling data with multiple sclerosis was published in 2007, 2008.
DrWP: Yeah, it’s been known for a while. And the other issues that we’re fairly certain based on our survey data that can be affected are neuropsychiatric disorders such as migraine headaches, major depressive disorder, anxiety disorders, and chronic fatigue.
IBD and the TSO (Trichuris suis ova) Porcine Whipworm
DrMR: Would you classify inflammatory bowel disease of course under the autoimmune conditions that are relapsing and remitting? Are you seeing some promising data there?
DrWP: Right. So the issue with inflammatory bowel disease is that the most work has been done with the porcine whipworm. It’s known as TSO is the therapeutic. It’s produced legally in Thailand. You can buy it. It’s kind of expensive. That’s the major drawback, honestly, for that worm is the expense. They purify it from pigs. They have to have a pig farm, so it’s not cheap to run and produce. They have to make it extremely clean because these are just farm pigs. These are not pigs in an isolator.
The most data are from that by an individual named Joel Weinstock. He’s the pioneer. When you talk about people who know a great amount, Joel Weinstock knows a great amount. He started this out, basically kicked off the field, the modern era, and published a couple of papers in 2005, showing that this particular worm works very well for IBD.
Now, unfortunately, and based on my studies, I think we’ve tracked this down and we understand that the follow up on that was lacking. And they changed the formula of the worm, and people were reporting that it doesn’t work anymore with this new formula. But that’s the problem of making one of these biological… It’s a living entity that you’re using as a therapeutic. It’s a biological therapeutic. If it’s going to cost tens of millions of dollars to test it, you only get one shot with one formula.
DrWP: The advantage that we have in our studies is that people are just trying it. So one person can try five, 10 different things and they let us know, “Well, this formula worked. This formula didn’t work. This one works for 10 days. This one works for six weeks, and then you have to take some more.” Those kinds of things.
But with a clinical trial, all your eggs are in one basket, tens of millions of dollars. And that’s what we think happened with the inflammatory bowel disease. The results were so promising with the porcine whipworm but then just did not pan out when they scaled up and they changed the formula.
DrMR: And when you say the formula, this is essentially how they were breeding the pigs and how that was affecting the worm itself or did they change the specific of a type of worm? Can you elaborate on that a little bit?
DrWP: Oh, absolutely. They changed the pH, which is the acidity of the solution that they used to store the worm in. So after you purify it, you have to store it to ship it to your customer or the patient. They changed that by a substantial amount. The acidity changed by a hundredfold, which is two pH units.
DrWP: It probably still works in pigs, but as far as we can tell, that’s what caused it not to work in humans.
DrMR: Gotcha. Ok. So there’s a lot here clearly in terms of preparation and replication.
Helminth’s Impact on Neuropsychiatric Conditions
DrMR: Coming back to neuropsychiatric conditions, can you list those one more time or some of the ones that you think are the most helped by worms?
DrWP: Right. Major depressive disorder, anxiety disorders. We get that over and over again. People are reporting anxiety disorders are dissipating or being attenuated profoundly. We don’t think this is a placebo for a number of reasons. One is that when it was initially found by these people self-treating, they were trying to self-treat themselves for a bowel condition or an allergy, and they were surprised to find that it was affecting their neuropsychiatric disorders. That’s one reason. And then secondly, they can usually tell how long it lasts.
Interestingly, many times, the individuals self-treating are hesitant to admit, “Yeah, this affected my brain function.” But their family and friends tell them, “Hey, this is affecting your brain function. This is a good thing.” There’s a lot of indicators.
There’s something called normalization to the mean. If you take a bunch of sick people and give them something, especially if you pick the very sick, desperate ones, the chances are they might just get better because you picked the sickest ones. The sickest ones are getting better and the better ones are getting sicker. There’s just some natural fluctuation. We’re talking about people that have had the disease for almost 30 years on average, based on our survey studies.
It’s a fairly substantial effect as far as we can tell. And again, it’s on anxiety disorders, chronic fatigue. We went back and did some laboratory animal experiments and looked at mental fog. And indeed, the helminths did protect the animals from mental fog that we could induce. You’re also looking at migraine headaches. I think that covers it. Those are the major categories.
DrMR: Ok. Now, while we’re on the topic of neuropsychiatric, autism is one that certainly comes up. I did find a very interesting paper. This may have been published recently, or I perhaps only came across it just recently. But it was a survey of physicians who were monitoring people who were self-administering helminths. And they found that 57% of the treating patients that were being observed in the study had autism.
And I know Nancy O’Hara has been doing a lot with kind of guiding people on using non-human-grade worms—and that’s something I want to get back to in a moment—for autism. But are you seeing results with autism also in the data that you’ve been culling through?
DrWP: Right. Actually, that was our publication.
DrMR: I thought it may have been. Ok.
DrWP: Right. So, yeah. It turns out we didn’t set out to study autism, honestly. What happens is that for a couple of reasons, parents who have children with autism are very willing to try alternative therapies.
DrMR: Sure. Sure.
DrWP: For better or for worse, a lot of our data come from people with autism. It’s important to note that this is not any kind of cure for autism. In fact, we’ve just recently published a paper with a group in Harvard. So it’s a Duke/Harvard collaboration that we’re excited about. We’re fairly convinced that it’s acetaminophen, or Tylenol is one of the name brands. But acetaminophen exposure early in life, from birth to say age five or six, that can induce a neurological damage that we refer to as autism.
That’s a different story, but it’s important here because if you view autism as sort of a chemical injury, and certainly that’s how it works in laboratory animals. We wouldn’t really expect the helminths to have a profound effect on autism per se, and indeed, we don’t. Autism is characterized by lack of understanding in social situations, just an impairment of social understanding. We don’t see any effect of the helminths on that.
But many of the patients with autism, about half more or less, give or take, have a tremendous number of inflammatory problems: digestive problems, neuropsychiatric problems not related to autism, and other issues such as allergy. Those are the kinds of conditions or they’re called comorbid conditions that are affected by the helminths or appear to be affected by the helminths in many of the patients.
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The Link Between Gut Health and Brain Function
DrMR: So coming back to the gut/brain connection. Are you seeing any of the non-autistic neurological impairments improve in these autistic kids? And that may be hard to evaluate, but just curious, are you seeing any neurological-like symptoms that may not be typical autism-like symptoms but are neurological improve? Let’s say if someone has diarrhea and they have autism. As the diarrhea improves, are other brain functions improving? Are you seeing anything like that?
DrWP: Right. Yeah, absolutely. What they’re reporting is that the listening gets better, ability to learn information gets better. Jim Adams has done some work in Arizona just looking at just fecal therapy. The bottom line is if you make the gut better, whether it’s with helminths or whether it’s the fecal therapy. Not a fecal transplant. That’s a different ballgame. That’s very specific for certain conditions.
But fecal therapy with healthy fecal material, then these kids learn better. They respond better. With the helminths in particular, we see, say, effects on ticks or the repetitive behavior, Tourette’s type problems, as well as OCD, other kinds of anxiety disorders. So we’re basically seeing the same thing with the kids that we are finding reported with adults.
DrMR: Gotcha. In my clinic, I do not see a lot of autistic children, but we have had a small sample of patients come in and the majority have responded to the different gut therapies that we do. And certainly, I see on a weekly basis, probably a daily basis, patients who see an improvement in brain fog, insomnia, fatigue, depression, after we improve the health of their gut.
So certainly, the gut/brain connection makes a lot of sense to me. I think we’re seeing some more being published regarding that in the published literature. So that’s not surprising.
Fecal Therapy vs. Fecal Transplant
How do you define fecal therapy compared to fecal microbiota transplant? How are they different?
DrWP: Right. So a transplant is very similar to what we do with an organ. And in fact, a lot of the work that I do right now is with transplant immunology. So with a transplant, you take out the bad organ. You put in a new organ. It’s one procedure, and you’re done. You monitor your patient.
With this therapy, what they’re finding is that you need to infuse the fecal material repeatedly. So it’s not just a single event. But it’s sometimes seven times a week, sometimes three. And then it’s done over a period of several weeks, if not months, to see a profound effect.
DrMR: Sure. Gotcha.
DrWP: And we think what’s going on there is you’re pushing the system back. You’re not necessarily—it’s not a transplant where you think of taking out the old organ, putting in a new. When fecal transplants really work is when your microbiota has just been accidentally destroyed by antibiotic treatment. So you’ve already taken out the old, and you plop a new one back in.
So this is clearly a different situation where the patient already has an established microbiota. It’s just not healthy. So you sort of have to beat that down with this kind of therapy, if you will.
DrMR: Interesting. Along those same lines, I was reading a paper last night that evaluated if one single fecal transplant, or using that term kind of loosely here, but one essentially enema and retention administered fecal transplant would be enough to change the course in ulcerative colitis.
Most of the studies that have shown—I believe all the studies that have shown favor with ulcerative colitis have used repeat administrations of the fecal therapy. This group found that one administration was not enough to cause any significant impact.
So I definitely think that there’s a lot to what you said there where you need this repeat exposure to have the impact, to have the effect.
DrWP: Right. And the problem is it all started out back in 1958 when some clinicians in Denver were looking at something called recurrent C. diff colitis. With that disease, that’s the disease where your microbiota’s just been wiped out by antibiotic treatment. So in that case, it only takes one procedure to take care of it. And of course, that’s been the standard. That’s been the typical use of the fecal material is to treat that condition.
So everybody was thinking, Well, it just takes one time. But that’s a special case because it truly is a transplant since somebody took out the old organ, if you think of your microbiota as an organ, which you could easily. It fits the definition. But in the case where your old organ is still sitting in there, then you need to pummel it repeatedly. And that’s certainly true with IBD or those kinds of things.
Helminths and IBS
DrMR: Now, what about IBS? One could also make the argument that IBS is relapsing and remitting. It does tend to follow that trajectory.
DrMR: Are you seeing any favorable impact?
DrMR: And if so, is there a certain subset, IBS constipation type, diarrheal type that seems to respond better or worse?
DrWP: So we don’t have the kind of resolution on our data collection that would allow us to divide it up into subsets, but we definitely can say, yes, it is affecting irritable bowel syndrome. But we don’t know what percent of the time. We have a good idea that it does have a fairly profound effect.
But the helminths seem to be affecting everything on the gut-brain axis. And certainly, IBS, it’s associated with stress. It’s on the gut-brain axis.
Histamine, Mast Cells, and other Mechanisms at Play During Helminth Therapy
DrMR: Sure. Ok. So how do you think it helps? I was reading a paper the other day that was putting forth the theory that one of the ways in which helminth therapy can be helpful is by stabilizing mast cells and potentially even decreasing histamine.
And high levels of histamine have been shown to cause abdominal pain, turbulence, diarrhea, and things like brain fog, anxiety, insomnia. So certainly, that seems like a plausible mechanism to me. But, again, wondering are there any main mechanisms that you think are at play here?
DrWP: Yeah, it’s a good question. And the insomnia, we do see effects on sleep, sleep disorders in our socio-medical study. In general, the way that we look at it biologically is that humans and any vertebrate going back 300 million years has basically always had a helminth, or they’ve always been exposed to helminths. So it’s something our immune system basically needs to see just like it needs to see bacteria. If you raise animals in a bubble with no bacteria, their immune system just doesn’t develop.
So what we think is in the modern climate, for the first time in all of the life on this earth since 300 million years ago, we have no helminths. What we think is our immune system just probably doesn’t develop properly and it puts us at risk for cancer, autoimmunity, allergy, neuropsychiatric disorders, and digestive diseases as well as heart disease. Just increased inflammation.
It does a very similar thing that an inflammatory diet would do, for example. Or it does something similar to a sedentary lifestyle and chronic stress. It just adds in to that horrible picture of Western society which we know is so unhealthy for us.
In terms of what it actually does, it certainly enhances regulation of the immune system. And I don’t think it’s just mast cells. It’s T cells. It’s dendritic cells. It’s granulocytes of all sorts. It’s probably every single component.
And part of the history of our research which I didn’t mention is we did a lot of studies looking at the immune system in wild rats and comparing those to the immune systems in lab rats. I think there you can see you’ve got animals exposed to helminths and animals exposed to no helminths. And of course, the wild rats are exposed to a lot of other things as well. But the bottom line is the immune systems of those two animals, despite being the same species, were wildly different, very, very different in terms of their regulation.
We found a lot of very interesting and surprising information about components of the immune system probably none of your listeners have ever even heard of. And any of those or probably all of those are contributing to the fact that we’re getting sick without our helminths. And that’s the bottom line is we think we just need them for proper regulation. Yeah, they do cause regulatory feedback loops.
One way that we look at it is that the immune system, it’s similar to a teenager. If you don’t give it something useful to do, it’ll find something stupid to do.
DrWP: It’s the bored teenager analogy of literally people in Western society have components of their immune system that are doing nothing, particularly the mast cells. There’s the B cells producing IgE. There’s some other components that really have nothing to do in the modern society, because we have toilets and clean drinking water, we’ve lost all our helminths and all of our protozoans.
So without those organisms, we can tell there’s some dormant immune components. And those dormant immune components are the ones that often cause problems.
Where to Begin with Treatment
DrMR: All right, so what about self-treatment? And I know you have to kind of be careful with being careful not to make any recommendations here, but I’m trying to provide for the audience, for someone who’s listening to this, or for a clinician who’s listening to this, trying to help their patient, or a patient who’s their own advocate trying to just figure out how to overcome “insert symptom here.” How can we provide them some guidelines?
Actually, from what you found in your study, there’s the HDC and the TSO worms, as your study reported, were the two most common helminths. Those are ones that I’ve come across in some of my interactions with patients, in some of my musings on the internet. Neither one of these, as I understand it, and please correct me if I’m wrong, are human-grade worms. So they only have a transient effect, so people keep retaking them kind of like a probiotic. They take a dose maybe every two to three weeks.
So I’m wondering for people—this is probably sounding like it’s the lowest barrier to entry to experiment with. So just wondering I guess if you have any thoughts at large for people who are suffering and considering this as an option and what you think about some of these non-human worms. Are they effective or are they not effective and I guess wherever you’d want to take us from there?
DrWP: I’ll be very clear just to start with that being at a major medical center, we don’t recommend that the patients try anything. Of course, at the same time, we don’t recommend that they don’t try anything either. We just can’t make any recommendations. Our data would suggest that for some patients this is the only available effective option. But that’s not a recommendation. That’s just an observation.
At the same time, they’re not tested in FDA-approved clinical trials. So we can’t recommend them. But the first rule in medicine is do no harm. So we can’t just say don’t try it, don’t try it, when, in fact, based on everything we know, it may be a very effective option and, in fact, the only option.
But it depends on the condition. For example, with fibromyalgia, it looks like helminths are not a good option for whatever reason and at least for a lot of people with that particular condition. A lot of what we do is trying to—we try to systematically collect information from the web, from books, from videos. That’s a small component. And then, most of our information actually comes from medical doctors who are treating patients that are using helminths.
So we try to systematically collect that, compile that, and we are using that as a basis for starting or designing clinical trials. And then, of course, the information is publicly available. It’s out there, so patients can look at it and gather the information. Unfortunately, at the present time, most of the folks who are using these have a primary consideration of money.
For example, there’s an incredible clinic. Garin Aglietti runs a clinic down in Tijuana, Mexico. And you just have to have money to travel down there and to spend the time at that clinic. And he probably knows as much as anybody in the world, more so than anybody, about the effects of helminths on human health and, in particular, people who have inflammatory disease.
At the same time, if you don’t want to travel, you can buy helminths from a couple of different companies. Biome Restoration in the UK sells the HDC that you mentioned. Tanawisa in Thailand sells the TSO, which we talked about before. So the HDC and the TSO, as you said, they’re the two most popular.
Both of them have similar effects as far as we can tell. The TSO is more stable in storage, but it’s more expensive. It really depends on—unfortunately, it comes down to money for a lot of individuals. The cheapest helminths are what you’re calling human-grade, but we will call them human-specific.
So those will live in humans, and they’ll lay eggs and grow to adulthood. The hookworm, the human hookworm is the most popular in that regard. It is the most inexpensive, but it does have the greatest side effect profile.
Unfortunately, right now you can’t go to the doctor. What we’re working on here at Duke is to try to get it so that one day you’ve got migraine headaches, and you will just be able to go to the doctor. He’ll say, “Oh, yeah, yeah. Take 30 of these and just take them every three weeks, and you’ll be fine.” And boom, your insurance pays for it. And depending on which organism it is, it’s not that expensive to produce. But right now, that’s just not the case.
So patients have to weigh in the cost and the potential side effects, especially if you’re using the less expensive organism, the hookworm.
Dr. Ruscio’s Resources
DrMR: Hey, everyone, in case you’re someone who is in need of help or would like to learn more, I just wanted to take a moment to let you know what resources are available. For those who would like to become a patient, you can find all that information at drruscio.com/gethelp.
For those who are looking for more of a self-help approach and/or to learn more about the gut and the microbiota, you can request to be notified when my print book becomes available at drruscio.com/gutbook. You can also get a copy of my free 25-page gut health eBook there.
And finally, if you’re a healthcare practitioner looking to learn more about my functional medicine approach, you can visit drruscio.com/review. All of these pages are at the drruscio.com URL, which is D-R-R-U-S-C-I-O dot com, then slash either ‘gethelp,’ ‘gutbook,’ or ‘review.’ Okay, back to the show.
Human vs. Nonhuman Grade Worms
DrMR: Now, do you see any trend in the data when you look at some of these human-grade worms versus the non-human-grade worms like the HDC and the TSO? The person I’m asking this question for is the person who thinks, Oh, maybe if I go to Tijuana and I get the human-grade worm, maybe that’s more effective. But maybe that’s not the case.
And so, do you see one having a trend toward being more effective than another?
DrWP: Yeah, that’s a good question. Most of the people we talk with are not—who have experience with multiple worms, they’re not very willing to compare multiple. They’re so different. And I can say that we had less reports from the human-specific worms, the hookworm in particular. We had less reports with a resolving neuropsychiatric problem, such as migraine headache.
But people trying those worms are more—probably sicker. Let’s just put it that way. If they’re dying from a digestive disorder, they might not report depression going away. Or they might just attribute their depression going away to the fact that they’re not dying from inflammatory bowel disease anymore. Whereas, somebody who’s just seeing if they can treat a peanut allergy, they would notice if suddenly their anxiety disorder dissipated.
It’s hard for us to know whether or not the human-specific worm, in particular the hookworm, actually works better, with the exception of probably lung conditions. The human hookworm tunnels up in through the skin. Then it eventually makes its way to the lungs and tunnels through the lungs. And that probably does have a fairly substantial effect on lung physiology that’s protective as long as you don’t have too many of the worms.
And of course, people self-treating, they know how many worms to use. They know the right number to use. Don’t use too many. Don’t use too few. So that’s been more or less worked out in that community.
Frequency and Dosing with Helminths
DrMR: So any thoughts from what the community has reported in terms of—and maybe we could break this down just to make this simple. If you have any of this data off the top of your head, we have those two organisms, the HDC and the TSO. Is there a typical dose people are using approximately? And is there a certain frequency of administration that people are using?
DrWP: Oh, absolutely. And it’s my job. I have those numbers off the top of my head. With the TSO, it’s about every 10 days to two weeks that those need to be taken. And the dose ranges from children, say, children might take 300 and adults might take between 2500 and 7500. And you start out… People start out low and then they move their way up.
And the issue is it gets more expensive. But for adults, that’s only a threefold range. With the HDC, the one sold by the UK company, the variability is more different. If you’re using their commercial product, you’ll find some adults that only need 20 every three weeks, but then you’ll find some adults that need 200 every week, which is less than the TSO, but it’s just a very different organism. And the hookworm—that’s the human-specific or human-grade worm—that’s a different dose altogether. It absolutely depends on which worm it is.
DrMR: And those are not going to leave your system. Am I correct on the premise that the HDC and TSO, they essentially won’t be able to live because they can essentially complete their lifecycle? They will die but the human hookworm will live. And so, is there not a need for long-term dosing with the human hookworm?
DrWP: Well, that’s more or less correct, but there’s caveats. With the HDC and with the TSO, every now and then—and we don’t know how common this is. It’s rare, but it probably occurs mostly in children and maybe in immunocompromised children. The organisms can take off and survive. So in some of those children, and we don’t know what fraction, some of those children can have severe GI cramps, which is what you typically get with over-colonization with any helminth.
For the most part, you’re right. The HDC and the TSO, and we haven’t had any reports of them living in adults unless the adults are immunosuppressed intentionally. And then, those adults actually don’t have any negative side effects. Of the reports we have so far, they report very beneficial reactions to the HDCs in particular, even when they are living and growing inside their GI tract.
So that’s one caveat. Most of the time, you’re right, they don’t survive. And you just retake them every one to four weeks, depending on which worm it is. As far as the hookworm goes, now the way the hookworm works is you probably need to maintain a colony of hookworms. And this is how we understand it based on what people are doing.
You need to maintain, for an adult, a colony of hookworms between 90 and about 110 in that ballpark. If you go much above that, you’re going to get a lot of side effects, which include GI cramping. And you can even have some side effects at the colonization rates that I describe, between 90 and 110, that are therapeutic.
At some point, with that worm, you can get fatigue and anemia and other kinds of things. What people do is they take a few of them, say 25-35, and they wait awhile. You don’t want to take all 90 at once because that’ll cause a lot of problems, again, based on the information we have. So you take a few, and then you build up your colony over time. And you let your body adjust to them.
And that serves a twofold purpose. One is that the side effects generally occurs when the worms are molting or when they go through a cycle change. So you don’t want them all going through the cycle change at the same time. And then, secondly with this worm, it looks like the older ones are not as effective.
We used to think that they could live four or five years, but people are reporting that they only last a year or so now. That’s just what people are reporting, so I don’t know why there’s a difference in what’s classically in the literature and what we’re seeing here. It may be a difference if you colonize a Westerner who’s never seen a helminth before. Maybe they just don’t last as long as if somebody who’s in a developing country is colonized with them.
DrWP: The idea is that you do need to take some… You need to take more of them every few months, but you’re not reestablishing your entire colony. You’re just sort of maintaining your colony every few months.
Potential Side Effects
DrMR: Gotcha. Ok. And you mentioned a side effect of abdominal cramps indicating too high of a dose. I’ve heard that it’s not uncommon for someone when they’re initially colonizing themselves to have a histamine-type response where they may feel a little bit foggy, irritable, flush. And I’ve heard recommendations to take something like Advil and an antihistamine.
I actually did do a self-experiment with HDC, just one sample. And I did have kind of an irritability reaction, took an antihistamine, took an Advil. It went away. That was the extent of my experimentation with it, but I guess a twofold question. Are there certain side effects from the initial administration people should be cautious of? And are there other side effects that may indicate someone’s going too aggressive with the dose?
DrWP: Right. So with the HDC and the TSO, and we have the most data with the HDC, you’re absolutely right. Especially with a lot of kids, we see an increase in hyperactivity. We’ve got at least three different suggestions from different physicians on how to get around that. And one is to use ibuprofen, not acetaminophen, but ibuprofen.
Another one is to just ignore it because it’ll go away. It’s temporary. And another one is to take that as a caution sign that you’re going too fast and just lower the dose a little bit, increase the frequency a little bit, and you don’t have to worry about it.
Usually, that side effect happens when you first start out or when you first increase the dose to a significant extent. So once you’re on them, apparently, as far as we can tell, that is not such a factor. Your immune system sort of reaches a steady state or a kind of equilibrium so that you’re accustomed to them. I think, looking at the animal models and the data coming out of the labs, that’s what we’re seeing.
If you’re under duress and you’re in danger of having a disease induced, that is not the right time to take a helminth. The right time to take a helminth is probably more—not that we recommend it, of course, but as far as we can tell is just when things are stable. And then, again, you can expect that it’s going to stimulate the immune system. You’ll get a temporary increase in inflammation, and then that’ll be followed by a down-regulation of inflammation from the original baseline.
DrMR: And that’s pretty much exactly what I experienced. I took one Advil, one antihistamine, and never had any problems from that one bout that probably started about an hour after administration. And it took me a couple of hours to connect the dots, and then I took an Advil and antihistamine. Within 20-30 minutes, symptoms went away and they never persisted.
So that makes sense. Now, on the other end, abdominal cramps are a pretty dead indicator that someone’s gone too high. Would you include other things in that, like diarrhea for example?
DrWP: With the HDC, what we see or what’s being reported to us is that if you go too high, you will get temporary diarrhea that may last the next day or so. And again, most of the individuals who understand what they’re doing, they’ll either just put up with it or they’ll take fewer organisms at a higher frequency.
DrWP: To try to get the colony level up higher without having to deal with the temporary diarrhea. Now, it goes back to these very rare cases where the animals just take off and start going. Then, you can get severe GI cramps, and those are persistent. Those don’t go away just after a day. And those are indicators that the individual really needs to go see a medical doctor.
They should be seeing a medical doctor anyway. All of the people producing these things suggest you need to do this under care of a physician. They need to go see a medical doctor and just get the organisms removed at that point.
Fibromyalgia Warning and Contraindications
DrMR: Gotcha. And for contraindications, you had mentioned fibromyalgia may be one condition that this does not work well for.
DrMR: I’m assuming people who are using immunosuppressive drugs is going to be another contraindication. But what are some contraindications that you may have pieced together?
DrWP: Well, the only thing we know for sure as a contraindication is fibromyalgia. If you have a mast cell overactivity, that may be a problem. You mentioned that the organisms can active mast cells. So if your mast cells are already paranoid, for lack of a better word, that could be a problem. We just don’t have enough data on that.
Immunosuppression, we honestly don’t know. A lot of the patients with IBD, for example, are on immunosuppression. And a lot of the patients with severe allergies are on some kind of immunosuppression. And the helminths seem to work fine in conjunction with the drugs they’re using.
Now, hypothetically, if your immune system is totally incapacitated, the helminths do require an intact immune system to function. So at some point, hypothetically, we expect the helminths just frankly not to work or to just start growing unabated and cause problems. But we do not know at what point that is.
DrWP: A lot of our work in transplantation tells us that there’s some components to the immune system that are so basic that you have to kill the patient to suppress those components. This may be one of those situations where there’s no modern immunosuppression which suppresses the immune system that much. But of course, modern immunosuppression stops before you kill the patient.
DrMR: Gotcha. Gosh, that’s pretty much everything I wanted to run through. Are there any other important thoughts, closing thoughts that you wanted to provide people with?
DrWP: One of the main feelings that we have about this is it’s almost just unfortunate that folks are right now at the point of having to educate themselves and take these sorts of risks to try these things if they’re really looking for a cure with helminth. And we really—that’s what our main goal is: to get around that. But that’s just the bottom line right now is there’s no clinical trials that you can rely on that will inform you of exactly which product to buy.
It’s one of those “enter at your own risk” kind of things. And the data we’ve collected hopefully will help inform folks, but it’s certainly not ideal.
DrMR: Now, is there any association where people can go to get guidance on this?
DrWP: Right. There’s all kinds of social networks online, and that’s mostly where people are going. But the problem with that is—and we’ve seen this too. So this is a good example. I know one physician who had 70 patients who were trying helminths. And the physician told me, “Hey, I’m certain all my patients love me. They’ll be glad to fill out a survey. And two of them are having substantial problems with their helminths and 68 are very happy.”
So we got two surveys back: one from a happy person and one from a not-happy person. What we’re seeing is—and many of the suppliers warned me about this. A lot of what you see online is the very negative because people are searching for answers. So if you’re still searching for an answer, you will write about it. Now people that it just doesn’t do anything, they don’t write about it. They don’t really care about it, and they just drop it and move on.
Many of the people that it’s helping are very happy with the help and they’re satisfied. So there’s no motivation to go out and be activist and write. So it’s hard to piece that together. We’ve been very fortunate with our studies, and they’re approved by an ethics committee here at Duke to reach out to people and try to eliminate those kinds of what’s called “survivor bias” and really find out what is the average person experiencing.
If somebody’s trying to educate themselves about what the average person is experiencing, I think the papers that we published are pretty good. They’re open source, online. If they can’t find them, they’re welcome to contact me. My email is available through the Duke website and so forth.
DrMR: And the website to—are you at a certain website? Is there somewhere people can go to see all your papers and such?
DrWP: Yeah. I’m sort of similar to a fungus on the web. If they just Google my name and Duke University, I’ll pop up.
DrWP: Yeah, if they’re interested in the helminth stuff, the first big paper we published was online. The second one you’re talking about with the medical doctors, that one may not be online. But I can send personal copies to somebody who’s interested.
DrMR: Okay. And I’ll put the link to that paper here, at least a link to the PubMed abstract in the notes that go along with this episode.
And I also just want to second what you said about the survivor bias. I see this with small intestinal bacterial overgrowth. When we diagnose that at the clinic, some patients look at me like they were just diagnosed with terminal cancer because of what they’ve read on the internet.
I’ve learned to tell people right out of the gate you’ve likely read about SIBO being far worse than it actually is, for the exact reasons that you’ve said. The people who are struggling with it, the people that have a very severe case, the people who maybe don’t even have SIBO but think they do and are just kind of floundering, they’re the ones who are going to be most vocal. So that’s going to give you a very skewed perspective.
I think this is really worth echoing for people because you oftentimes get the worst-case scenario perspective when you read on the internet for the exact reasons that you outlined, William, which is unfortunately the most severe, the most sick, the most unresponsive tend to be the most vocal also.
So just factor that in for different items that you read about on the internet so as not to, I guess, placebo yourself into thinking that the condition is actually going to be worse than it is.
DrWP: That makes a lot of sense.
DrMR: William, this was a very enlightening chat. Thank you so much for taking the time, and thank you for the good work that you’re doing.
DrWP: Oh, thank you very much. And thank you for having me here. It’s been a pleasure.
DrMR: Pleasure also on this end.
What do you think? I would like to hear your thoughts or experience with this.
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