Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
21 Jan

Are Parasites Primal?

HookwormThe environment of ages past has shaped who we are today, even (or especially) the difficult, unpleasant stuff – this is the foundation of ancestral health. Take exercise. Early man’s daily life was one of frequent, constant activity interspersed with infrequent bouts of intense activity. Hard exercise is, well, hard and physically unpleasant in the moment, and constant low level activity is often untenable given modern schedules, but both make us stronger, healthier, and ultimately happier. Intermittent fasting, while difficult, can be beneficial when artificially imposed today because our genome evolved under periods of nutritional stress where food was scarce. Going without food from time to time was expected; it was our genome’s evolutionary backdrop. Our bodies evolved with these hardships as assumed and inevitable aspects of the environment. Our modern bodies function best when exposed to these hardships.

What about another almost unavoidable aspect of the ancestral environment – parasites? Do our bodies expect and function best with a few (dozen) worms along for the ride? You know about gut flora’s effect on our immune response and overall health, but does the fact that our immune systems evolved with the presence of various helminthic worms also have implications for our health?

A growing number of researchers think it’s likely. They posit the “Old Friends Hypothesis,” which suggests that helminthic worms and other parasites commonly assumed to be wholly pathogenic are actually “old friends” that can provide a steady, low-level anti-inflammatory buffer that reduces the incidence of autoimmune diseases like celiac, multiple sclerosis, type 1 diabetes, and Crohn’s disease. Populations with high parasite loads tend to display a remarkable absence of autoimmune disease as well as distinctive genetic markers that bias them toward higher baseline inflammation levels that are only held back by the presence of worms. Many of the alleles associated with having parasites are also associated with celiac, multiple sclerosis, colitis, diabetes, and rheumatoid arthritis, which suggests parasite/host co-evolution. In the presence of worms, maybe those alleles become harmless.

If you’re wondering why worms would ever be a “good thing,” you have to realize that helminthic worms are stubborn. They get lodged in there. They can’t really be removed by our immune system because the inflammatory response required to do so would damage the host (that’s us) more than keeping the thing around would damage the host. In turn, the worm doesn’t want to overstay its welcome by taking too much from the host and killing it. So, the host adapts to its inextricable bedfellow, while the bedfellow adapts to its host by modulating the host’s inflammatory response. And in time, it becomes reliant on the parasite, and the parasite becomes an external fixture of our immune system. It’s not really part of us, but we treat it like it is because it’s been there for so long over so many generations that we can’t function without it. We’re used to the inflammatory buffer. Humans have encountered many different species of helminth, and most, if not all of them modulate immune function in unique ways.

And when it’s no longer there, when we move to cities and stop having parasite-enriched dirt under our fingernails, when we enact widespread sanitation measures and clean up our water and throw our trash away in nice neat bins that get cleaned every week, there are unforeseen consequences. Even though infectious disease rates and deaths from infectious disease drop, and more infants make it through to adulthood, there’s no free lunch. As long as the old friends are there to buffer against the elevated inflammation, autoimmune disease is relatively absent. When the old friends are withdrawn (like through anti-helminthic therapy), autoimmune disease and allergies increase.

So, what should we do? Go spelunking in a rural Indonesian porta-potty? Take shots of Ganges River water? French kiss a pig? You’d actually be surprised. One guy cured his asthma by walking barefoot through the latrines of Cameroon. While that may be the “most Primal” way to do things, it’s not advised. As mentioned earlier, there are a lot of parasites out there whose effects we don’t quite understand and there are plenty whose effects we know to be pathogenic. Inoculating yourself with random wild helminths could cure your allergies or it could give you tapeworm (or both, I suppose).

Trials have been completed and more trials are underway, and the results are extremely promising thus far. Just so you know I’m not pulling your legs, let’s go through a few of them:

Inflammatory bowel disease (Crohn’s, colitis): Epidemiology suggests a protective effect of childhood helminth exposure on IBD risk, but what about controlled trials in adults? In one case, patients with Crohn’s disease who were exposed to hookworms had less reactivity to the parasites than controls without Crohn’s; the hookworms were less of an “immune insult,” and presumably more of an aid.

Allergies: A number of helminth species down-regulate allergic responses to otherwise harmless antigens by modulating the immune system, but some species appear to have the opposite effect (common roundworm infection for example has been associated with asthma and shrimp allergy). The children of mothers given antihelminthic drugs during pregnancy tend to have more infant eczema, which may presage future allergies.

Asthma: One study found that hookworm infection mildly improved airway responsiveness in asthmatic patients, with no effect on other parameters of asthma, but the dose was small – just 10 hookworm larvae. The most common dosage for hookworm therapy is around 35 larvae, so it’s possible the dosage was just too low.

Multiple sclerosis: Via a retinoic acid-dependent pathway (eat your vitamin A!), helminths have been shown to modulate the immune response in multiple sclerosis patients. Those who were infected had better outcomes than those who were not.

Celiac disease: Human hookworm infection suppresses the inflammatory immune response to gluten normally seen in patients with celiac. It even improves mucosal immunity and may help heal celiac patients, not just suppress their response. However, another study using an oral wheat challenge (equivalent to 16 grams of gluten a day, which is a fairly high dose) in celiacs found no benefit to hookworm infection.

Helminths may also be a potential therapy for atherosclerosisjoint inflammationautism, and type 1 diabetes (PDF, if you catch it before it develops). They seem to have a favorable impact on gut microbes, restoring the mucosal lining and rebalancing the floral communities to be less inflammatory in macaques with diarrhea, so there’s probably a role for general immune and digestive health as well.

Okay, that’s cool and all, but we’re still dealing with worms wriggling around in your gut. There’s little else more unnerving and repulsive than the thought of hookworms setting up shop in and gnawing on your small intestinal lining. And there are dangers to helminths, particularly in developing countries where people tend to be malnourished, absent access to medical care, and carry large parasite loads. Most intestinal worms consume blood. Get enough of them lodged in there and you can end up with anemia, malnutrition, growth deficiencies – especially if you’re a young child.

But anemia only occurs when people are getting reinfected due to frequent contact with parasite-laden fecal matter in the environment and the parasite loads get out of hand. In a controlled, clinical setting where infection is carefully curated (to prevent reinfection) and the patients have access to plenty of nutritious food and medical care, it’s far safer. As it stands now, helminths must satisify certain safety and efficacy parameters before being considered for therapy. Qualifying worms:

  • should not have the potential to cause disease in man at therapeutic doses
  • should not be able to reproduce in a host, thus allowing control of dose
  • should not be a potential vector for other parasites, viruses, or bacteria
  • should not be easily transmissible from the host to other people
  • should be compatible with a patient’s existing medication
  • should have a significant period of residence in the host
  • must be easily eradicated from the host, if required

The majority of clinical trials of helminthic therapy have a relative paucity of adverse reactions. Diarrhea, stomach upset, and skin irritation are the most common side effects, but usually only for the first few days and not in everyone. If it were to get out of hand, anti-parasite drugs are effective, fast-acting, and safe.

Grok definitely had parasites, but he probably wasn’t loaded to the gills, instead carrying just a few select species. The most prevalent helminth among a group like the San Bushmen, for example, is necator americanus, the human hookworm (PDF) species thought to have the most therapeutic potential. The largest parasite loads are seen in agricultural communities whose inhabitants have close, constant contact with animals (and their waste) and each other (and their waste). Hunter-gatherers had (and have) higher parasite loads than modern industrialized populations, but not as high as agriculturalists because they were steadily on the move and switched locations when parasites and parasite-laden feces became a problem. When hunter-gatherers hunker down and become sedentary, parasite infections skyrocket.

Pig whipworm is a current favorite among helminth enthusiasts, since it’s non-native to humans, it doesn’t survive for long and it doesn’t reproduce in the human host. This prevents overpopulation, but it also necessitates frequent re-dosing of eggs to maintain treatment, which gets very expensive. Treatment with pig whipworm can easily hit thousands of dollars per month.

Necator americanus, the human hookworm, appears to have the most potential against autoimmune diseases. It’s native to humans, cost-effective (lives for 3-5 years inside the host after a one-time infection), and sheds its eggs in the feces. As long as your feces are going into a toilet and not your backyard, there’s no chance of increasing your parasite load from reinfection.

This information isn’t easily actionable, not like information about exercise or diet or sleep is actionable. First of all, worms are scary. Way scarier than trying squats or eating liver or setting a strict bedtime. Parasites can be problematic, and many of us really have no way of safely inoculating ourselves. Which ones? Where do we find them? What if we mess up and get something really pathogenic? After all, the people who do carry parasite burdens generally don’t go about looking for them; they just pick them up through incidental, everyday contact. Clinical trials are underway, and I’d imagine the FDA will be getting involved soon enough.

If you are interested in helminthic therapy, you’ll probably have to handle things yourself. Here are a few ways to learn more, but please be advised that I don’t recommend, exactly, you do any of the following, and suggest you consult with a doctor before proceeding:

You could join the helminthic therapy group on Facebook and/or the Yahoo mailing list, where you’ll gain access to plenty of likeminded souls with extensive personal experience with worm therapy, as well as helpful resources, links, and advice. Brave souls are even doing some clandestine unregulated worm trading.

Nearly everyone but US residents can have worms shipped to them by Autoimmune Therapies.

US residents will have to truck it down to Worm Therapy, which operates out of Tijuana, Mexico, just across the border from San Diego. They offer hookworm and whipworm. Another option is to contact Coronado Biosciences, a company that’s currently running US trials for pig whipworm in Crohn’s disease in a number of cities across the country.

Also, mention it to your physician! He or she may balk or cringe or shower you with condescension, but it’s a good idea to be under medical supervision when infecting oneself with helminthic worms. And hey, if it works – and there’s a good chance it might – you very well could change an influential mind.

Is there a role for helminths in general health and immunity? Probably. But I’d wait for more research to take place before having nematode eggs and bacon for breakfast. If you’re suffering from any of the diseases shown to be modulated or improved by helminthic therapy, however, it might be worth researching.

What about you guys? Grossed out? Intrigued? About to book a trip to Cameroon? Let’s hear your reactions in the comment section!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Brilliantly elementary.

    Erica wrote on January 22nd, 2014
  2. I hope non of the people to whom I have been recommending PB find this article first! Cos I’ve probably lost them!

    Wendy wrote on January 22nd, 2014
    • was just thinking that same thing! just passed this website on to a patient at my dental surgery today… he will DEF think I’m nuts, now!

      michelle wrote on January 22nd, 2014
  3. Cool article. I have no problem with the idea, and am not grossed out by it whatsoever. Whatever works.

    But I have no known allergy or any obvious auto-immune issue, so I can speak, eh 😉

    La Frite wrote on January 22nd, 2014
  4. I wonder if I’ll be changing any doctors’/nurses’ minds soon. My dog attack hand gash is much better than it was and I’ve been dealing with it naturally. A few doctors and nurses told me I needed or should take antibiotics and many people looked at me with doom in their eyes saying “THAT’S TOO INFECTED” because it looked a bit scary but I refused them all. I used raw honey as a salve and that worked excellently (one doctor said he worked in Africa and used to use honey on patients’ cuts there all the time and used it to heal a similar wound to mine from a knife on himself) and a bit of some natural cream from a supplement store where the lady who works there is a saint and keeps giving me free samples and even brought some meal replacement stuff for me from home.

    Animanarchy wrote on January 22nd, 2014
    • I went back to the hospital and proved I didn’t need antibiotics and they still said I ought to take at least one. Then they wouldn’t give me my stuff back after I took a handfull of rhodiola pills and some organic molasses. They thought I was trying to get further shpongled.
      The reason I was there is that I got punched out when I was too drunk. I don’t remember it happening. Apparently I tried to “break in” to an apartment building, a few doors down or so from one I’ve been known to visit regularly, and “security” or “the bouncer” or “a few of them” attacked me. I wonder why and if it was someone from around that doesn’t like me taking advantage of my inebriation.
      I woke up in the hospital. Catscans show I have some minor jaw fracturing that does not require surgical intervention. I have black eyes. My cheeks are swollen.

      Animanarchy wrote on January 25th, 2014
      • Its nice to hear that the hand is healing up nicely with the honey. Sounds like you know what to do to heal your body, but what’s with the “me taking advantage of my inebriation” business? I get the feeling that you may be close to a break through there too, perhaps? None of my business tho.
        Nice to hear from you. I will put a jar of raw honey in my “emergency kit” thanks to you. :-)

        2Rae wrote on January 25th, 2014
        • I feel like I should answer your question rather than just respond.
          I was ‘double speaking’ George Orwell style as a joke

          Animanarchy wrote on January 30th, 2014
        • Or you could go another way and incoorporate Tolkien dwarven doors – I was also thinking of that friend

          Animanarchy wrote on January 30th, 2014
      • As it turns out, I was told by a reliable friend that I was lying down on the floor drunk and the super intendent started to beat me. I thought me might have worn a ring due to two dents in my facial epidermis but I think they were caused by boots.

        Animanarchy wrote on January 25th, 2014
        • I went back to talk to the guy once I found out who it was and he started swinging at me again. He wanted to get in close so I took him down on his back by wrapping my left arm around his neck and taking him to his back and then I gouged his closed eye a bit with my thumb. When the other two guys watching said it was enough I got up and he got up and cried out, “My eye!” so I can be sure it hurt him. Eye for and Eye.

          Animamarchy wrote on January 29th, 2014
        • Sorry for the cornucopia of successive comments. Just adding what I think is the final installment. Some time after the second altercation I had a brief argument with the guy again and then (I think within about a month) he had three heart attacks and had to be brought back in the hospital. I hear he has a bad heart and wonder if those arrests/arrhythmias/whatever were at all influenced by the stress of the violence or arguing. I was trying to cause an overload of stress for him at least, thinking of how it could be harmful.
          The breaks in my face healed fine enough. I look the same on the surface at least.The jaw fracture was apparently broken inwards. When blowing my nose a few days after I felt some pressure in the area building with the force of my blowing and then felt something go pop so I think that was the broken part[s?] popping back mostly to place. I guess it was a freak event of bone setting.There’s just a little bump under my skin there now and no debilitating effects or lasting pain.

          Animanarchy wrote on March 8th, 2014
  5. There’s certainly a precedent for beneficial symbiotic relationships in the human body. I wonder if anyone has done research into whether or not there is a synergistic effect between the host’s and the parasite’s responses to a common pathogen. There’s also a question about how much of the benefit from a parasitic habitation requires an adaptive response, and how much is inborn response.

    Grokstar wrote on January 22nd, 2014
  6. This is really intriguing. I’ve recently been diagnosed with an IBD but luckily it’s mild. If it were worse I would be all for trying this therapy. Its cost prohibitive otherwise for such mild symptoms at this time.

    Callah wrote on January 22nd, 2014
  7. I’m weighing in. I had Fibromyalgia/Celiac issues and I was in so much pain for so long, I would have tried anything that sounded like a possible fix, even a worm.

    Lisa Wagner wrote on January 22nd, 2014
  8. Everyone I know thinks that my eating bacon and eggs is gonna kill me… Don’t think I will mention the ‘worms are good for you’ message!

    Rachael wrote on January 22nd, 2014
  9. I have no personal experience with this subject, but I have to recommend the book “Parasite Rex” by Carl Zimmer to anyone who’s interested in the role parasites play in life, evolution, and ecosystems throughout the world. Zimmer is a biologist & the book is packed with fascinating scientific info (though it’s also pretty much guaranteed to gross you out).

    Emily H. wrote on January 23rd, 2014
  10. Mark is nuts. Just because it’s paleo/primal doesn’t mean it’s advised and healthy. Better ditch the toilet paper and start wiping with pinecones and twigs. People, toilet paper is not primal, and I just can’t imagine what Mark wipes with. I work at an animal shelter. The whole building is covered with poop. You better believe everything has poop on it… EVERYTHING. Co-workers don’t wear gloves, and they frequently get sick. I see worms and parasites from animals daily. They vomit, have diarrhea, skin infections, have all kinds of sicknesses. These animals are not healthy and dewormers and antiparasitic stuff are used frequently.

    Gabie wrote on January 23rd, 2014
    • Please at least take the time to read the article before trashing it in the comments. You will notice that he mentions specific species MAY help with certain disorders. I don’t think I saw anywhere in the article where he makes the case that all parasites are symbiotic and helpful. This is interesting and thought provoking and doesn’t warrant needless trashing from those without reading comprehension.

      Jason wrote on January 23rd, 2014
  11. The studies that Mark cited do show some suggestion of worms being an effective therapy for autoimmune conditions, but they obviously still have a long way to go before being suggested as treatment.

    I think that the whole way this issue is being studied is wrong though. Worms (and other natural parasites) aren’t meant to be introduced after the manifestation of an autoimmune condition, but rather early in childhood and continuously throughout adolescence. Studies like that would take at least 20-30 years to be conducted though.

    VI wrote on January 24th, 2014
  12. Highly recommend ‘An Epidemic of Absence’ for anyone who wants to know more about the relationship between parasites and autoimmune disease. Very interesting read.

    Kate wrote on January 27th, 2014
  13. I was just in a hospital for three days under a form one because someone called the cops on me when they saw me take an extra dose of pharmaceuticals. When the cops showed up and found out I wasn’t trying to hurt myself they called an ambulance. It didn’t do much to help me. They pumped me with 0.9saline constantly and I got to shower twice and eat a crappy diet, and some of the food I had with me = sardines, bananas, oranges (from lobbies). My creatinine level registered 30000. They say it’s normally supposed to be 500. It was time for an ab workout though so I hooked my feet under the bars of the bed and did 100 situps, then a set of 30, then I was put in restraints for a while.

    Animanarchy wrote on January 30th, 2014
  14. I think it’s very interesting and intriguing; however, the gross-out factor is extremely high!

    Jill wrote on January 30th, 2014
  15. I started having symptoms of MS when I was 16, which I then got diagnosed with after an MRI following my 2nd relapse 2 years later. I put my name down for receiving information on any clinical trials, and the only one was a helminthric therapy trial on hookworm infection. While I didn’t participate in the end, I have since wondered how much impact my repeated roundworm infections had (mud pies, climbing trees, making dens etc all whilst I still bit my nails may have accounted for this!) While Mark mentions roundworms as a negative in this article, it was what else the pills wiped out of my system in addition to the roundworms that always concerned me.

    Harriet wrote on February 11th, 2014

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