The subtext of this article is, “We got white people problems!“. Humor aside, it has not escaped the notice of the medical community that autoimmune disorders (including Crohn’s) are almost entirely exclusive to first world, developed countries. Visit places less developed, and you will find something interesting. Rather, you WON’T find something interesting… you won’t find asthma, IBD, MS, psoriasis, eczema, food allergies, or any of the other non-contagious autoimmune diseases that one finds here. That’s not to say they don’t exist there, but they exist in numbers that, at one time, were more closely reflected in our own culture. Crohn’s occurs in something like 1 in 10,000 people, as opposed to first world countries, which are seeing rates closer to 1 in 250.
While most researchers are asking questions like, “What’s changed that’s causing increased rates of autoimmune disorders?”, or “How can we better manage symptoms of autoimmune disorders?”, there are a few out there that are asking a different question…. “What’s occurring in the developing and undeveloped countries that’s *preventing* this increased incidence?”. This is a fundamentally different approach.
More than one researcher has concluded that one of the primary factors that is now missing in our developed world is the prevalence of parasites, in particular, gut-residing worms. Helminths are a class of parasitic worm that includes hookworms and whipworms. Some helminths are incredibly dangerous and can lead to anemia, malnutrition, even death. Others are more innocuous, however.
Helminths generally invade during the larval stage by burrowing through the host’s skin (they are quite small… microsopic, even). From there, they make their way into the gut and take up residence, where they feed on whatever the host eats. Their eggs or larva are evacuated along with the host’s poo, and there they wait until either another host come along or they die.
“How the heck”, you might ask, “does this help to reduce instances of Crohn’s??”. After all, if Crohn’s is the result of an over-active immune system, wouldn’t adding a parasite to the mix only aggravate the immune system more? That’s a totally reasonable conclusion, and according to these researchers, totally wrong. Think about it… how tough would life be as a parasite if you had to deal with being attacked by the immune system all the time? The thought is that helminths have developed a mechanism for actually *calming* the immune system, thereby making the host more hospitable.
Another part of the theory behind helminthic therapy is the learning nature of the immune system. The human immune system is a learning system that develops proper response as a result of stimulation. Medical sciences in the industrialized nations (and the easy access to medical care) has resulted in an environment where our immune system is exposed to relatively few stimuli. As such, it is never properly ‘calibrated’. The introduction of helminths gives the immune system something to work with, and helps to teach the immune system proper response.
As a theory, it’s all well and good, but there has actually been some clinical research into the effectiveness of helminthic therapy, specifically targeting Crohn’s. In that study, fully 75% of the patients went into full remission, apparently as a result of the introduction of pig whipworm into their gut. More info here: Wormy Cocktail Fights Crohn’s Disease
Obviously, there are some pretty serious hurdles to introducing helminthic therapy as a mainstream treatment for Crohn’s. There’s the obvious ‘icky’ factor at play… as a culture, we have not only excised most parasites from our physical existence, but we’ve imbued them with a powerful ‘wrongness’. But aside from that, there are serious issues with regulation, quality of production, distribution, etc.
I found the wikipedia article on the subject fairly informative, but there’s been quite a bit of buzz floating around out there. See also: Hygiene Hypothesis.
Personally, I think I’d have some difficulty following this therapy unless I’d exhausted a few other options first. It’s certainly less undesirable than, say, corticosteroids. But the aforementioned ick factor would definitely be a hurdle. What about you? Have you considered it? Would you?
This is a really fascinating area of…ethnography? Parisitology? Psychology? Sociology? Epidemiology? Really, all of the above. Even though I don’t suffer from an autoimmune disorder, I’ve been strangely fascinated by the multifaceted issue of the symbiotic relationship between parasites and humans.
I remember listening, rapt, to a story on NPR about a chronic asthmatic who, out of desperation, went to a third world country to wade in unsanitary mud in hopes of acquiring a parasite that has been proven to reduce or eliminate the asthmatic response.
So many of the problems in this space resonate with me. For example, when I tell people of my dream of having vat-grown steaks (that have never touched a real cow, only the necessary genetic material), people (who enjoy “real” steaks) often respond with revulsion. My thought is always “have you ever seen a slaughterhouse? And this idea is more grotesque to you?”
In our gleaming, germ-conscious, anti-microbal first-world existence, we’ve really forgotten something important: that we are just evolved worms our own selves. Furthermore, most people are woefully unaware of the magnitude and diversity of the distinct organisms that co-habit our bodies.
I understand the culturally-acquired revulsion of parasites. I am no impartial and superior observer of culture: I am, like my friends and family, a result of it. And the thought of intentionally ingesting a _worm_, for chrissake, is fairly nauseating.
However, are we not self-aware? Do we not have the capacity to recognize culturally-motivated irrationality in our own behavior? Do we not have the wherewithal to say “yes, this worm will make me more healthy, not less?” Who among us hasn’t swallowed an uncomfortably large pill, or a foul-tasting tincture?
Would I welcome parasites? Uncomfortably, maybe, but yes, I would, but I’m weird.
I know this reply is already ridiculously long, but I have one more thing to share: when I was in college, I developed a concept for a short story (possibly even novel material) that depicted a future in which our revulsion of parasites had been turned on its head. Genetic engineers had constructed the perfect parasite: a worm that ate only the worst and most harmful substances, leaving only the good stuff for us. Big pharama, in one fell swoop, allowed people to eat whatever shitty thing they want (tripple-deck hamburge with bacon and a pile of french fries? bring it ON), and the worm would selflessly take take the cholesterol and the fat and the excess calories. The dark and dystopian part of my story was that, of course, these genetically-engineered worms had been monetized. They were exclusively the province of the privileged. Instead of being appalled at the idea of getting a worm (ick!), rich debutantes fantasized about the day they’d be old enough to receive their very own dream worm. They’d even name it, in a ceremony.
Anyway, there’s some dystopian sci-fi gold if anyone wants to steal my ideas.
In the meantime, file me under: pro-worm.
I would totally read that book!
I think it’s fascinating that we are beginning to see more and more of a return to medical techniques that had been previously abandoned as unsanitary or otherwise dangerous. The use of maggots for debridement, for example, or leeches for draining limbs swollen with blood. I would, without a doubt, prefer the use of gut parasites for treatment over immune suppressants or steroids. It feels much safer to me and more targeted to me.
Pingback: Crohn’s Treatments: Fecal Transplant « My Cranky Gut
From what I read the worms only live about 5 years. And you have to travel to Mexico to get them.
Thanks for the info! I’ve heard a lot of conflicting info about the life span of the worms… Perhaps there are different species that are used? And sadly, I believe it is indeed illegal to sell the worms in the US, though there’s nothing to prevent one from intentionally contracting them.
why would you need them after one dose? once your immune system is back on track and you maintain it with proper SCD etc why would IBD return?
Interesting comment, Alexandra.
I think there remains a lot of question about whether or not helminthic therapy can actually *CURE* IBD, or if it just makes the symptoms go away. I know there have been some very interesting clinical studies in Europe, though I haven’t personally read the reports. I wish I knew enough to give you a real answer to your question.