Rational Wellness Podcast 038: Worm Therapy with Dr. William Parker

Dr. William Parker talks about Helminth Therapy, the therapeutic use of worms that are eaten and grow in your intestines to promote your health, with Dr. Ben Weitz. This may sound crazy, but recall when we found out that bacteria were the cause of disease in the 1800s and we figured out that we could kill bacteria with antibiotics and antibacterial soap and using modern sanitation methods like toilets, refrigerators, and water treatment centers. It wasn’t until the 1990s when we realized that there were beneficial bacteria growing within us in our intestines, our skin, our mouths, our mucous membranes, etc..  We learned that consuming live bacteria in the form of probiotics and fermented foods could improve our health.  And consider that for thousands of years, humans developed with bacteria, fungi, worms, and protozoa growing within us.  Today we know that we have a loss of diversity of our microbiome. We don’t have as many species of bacteria in our colons and this is partially because we live in such a clean, sterile environment compared to our ancestors.  This lack of exposure to pathogens has led our immune system to become dysregulated and this has increased autoimmune disease risk. This leaves our immune system with nothing to do and at times to attack our own tissue. This may occur through the mechanism of molecular mimicry whereby our immune system attacks protein found in our tissues that resemble proteins found in pathogens. Dr. Parker uses the analogy of leaving your teenager home alone with nothing to do–he or she is likely to do something stupid. Without bacteria, viruses, fungi, or worms to attack, our immune system attacks our self. 

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Podcast Details

3:47 I introduced Dr. William Parker as a Duke University professor who is one of the world’s leading experts on Helminth therapy.  I asked how he got interested in Helminth Therapy?  Dr. Parker said that he was working on studying microbes and microbiotia before it was called the microbiotia. They were studying the gut bacteria and they figured out that the immune system was supporting the gut flora and they figured out that the purpose of the human appendix is a safe house for beneficial bacteria, which is what his lab is best known for. But they were also interested in figuring out about diseases, like inflammatory bowel disease, and one of the things that he thought about is that in rats, the appendix is normal, but in modern humans something has gone wrong since the appendix gets inflamed for no reason and a large percentage of people have to have it taken out. So the situation with the appendix is kind of like a form of mini inflammatory bowel disease.  Appendicitis was virtually unknown during early history since there would have been some discussion of it, since without having it removed there is a 50% rate of death with appendicitis. You can read about how in the late 1800s surgeons were very interested in why they were suddenly starting to have so much appendicitis. We have a good cure for appendicitis, which is just to remove it, but we have much less of a cure for inflammatory bowel disease.  And inflammatory bowel disease also appears to be a modern disease. Dr. Parker said that he was trying to figure out why this was happening and the hygiene hypothesis was evolving at this time. They thought about their rat models and noted that their laboratory animals have this disease but what about wild rats?  They should be more like our hunter gatherer ancestors and they went back and studied these wild rats and found out that nearly everything about the immune system was different, including how antibodies are made, to compliment, to all the different cells in the immune system. Then they took lab rats and put them out in the wild and the big difference was not so much in their microbiome, which is largely related to diet, but what has been completely washed out are the complex eukariotic symbionts like protozoans and intestinal worms.

9:16  Inflammatory bowel disorders, like Ulcerative colitis and Crohn’s disease, are very difficult conditions to treat and these patients often have inflamed and ulcerated intestinal mucosa and it looks like from some of the studies I’ve seen are conditions that worm therapy may benefit. Dr. Parker answered that he thinks so, but it’s not proven yet.  Joel Weinstock in 1999 was looking at the effects of helminths on inflammatory bowel diseases and he found that the patients who were not responding to pharmaceuticals were responding extremely well to the porcine whipworm (TSO). He published papers in 2005  https://www.ncbi.nlm.nih.gov/pubmed/15825065 and in 2007  https://www.ncbi.nlm.nih.gov/pubmed/17313951  looking at both Crohn’s and Ulcerative Colitis and found that this TSO worm to be effective and you can still buy that worm today–it is produced in Thailand. What happened next is that they spent tens of millions developing this and they did a phase 2 trial and it did not work very well. What went wrong is that they changed the formula of the worm. You can think of worms as exercise for the immune system. Secondly, since they are not a chemical, if you change the pH, the acidity, they don’t work as well.  They changed the formula for some complex reasons, which is why it didn’t work.

13:32 I pointed out that this Helminth therapy fits very well with the Functional Medicine model. The traditional medical model involves using immune suppressing drugs like Humira, which don’t do anything to affect the cause of the condition. In Functional Medicine we try to balance and regulate the immune system and these worms seem to have a similar effect and seem to affect T-regulatory cells. Dr. Parker said that there are a couple of things that are very interesting. Let’s talk about Vitamin D insufficiency, for example. When he goes to conferences he often hears that they’ll talk abut how patients who are low vitamin D and vitamin D supplementation helps those patients in so many ways–neuropsychiatric function, immune function, etc. Based on our studies, patients are getting the same benefits from getting their Helminths back. He refers to getting Helminths back because it’s something that we lost between 1850 and 1950 and there are epigenetic effects which builds generation after generation. But he feels you get a bigger bang for your buck with Helminths than with vitamin D.  Dr. Parker also explained that in his wild rat studies they did not see any effect on T regulatory cells, but they saw effects on macrophages, T cells, B cells, etc. Modern immunology has recently been focused on T reg cells but that is the flavor of the month. It might be T reg cells or toll like receptors or the fast ligand.  Despite learning more and more about the immune system, immune disease keeps getting worse and worse. Dr. Parker said that Helminth therapy fits well with Functional Medicine but you can’t prescribe or give worms to your patients, since it is not approved by the FDA. Getting these helminths can be a tricky thing.

16:47  I said that I guess it’s not illegal to order them online? The United States is the only country where you cannot legally ship a helminth for therapeutic purposes, so the companies that are shipping them to people in the US are violating some regulation, though it is not a federal crime. 

17:20 There are other autoimmune conditions that helminths are beneficial for, such as MS.  You wrote that autoimmune conditions that are relapsing and remitting tend to respond better to helminths, like MS. Dr. Parker explained that Dr. Joel Weinstein looked at inflammatory bowel disease and another group looked at asthma. Some folks have looked at autoimmune diseases such as multiple sclerosis, including a group in Argentina that published a landmark study on this showing that patients with MS who were accidentally infected with helminths had complete resolution of their condition. https://www.ncbi.nlm.nih.gov/pubmed/17230481  Here is a review paper discussing this and other studies on this:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5666823/  If they lose their helminths, their MS will come back. Helminths help with the relapsing and remitting form of multiple sclerosis but don’t help as much with the progressive form of MS.  Similar effects are being seen with allergies. Someone who is allergic to mold in their house where they are just not getting a break, helminths don’t help as much as they do with seasonal allergies. The first report of humans having having a therapeutic effect was by a British parasitologist named John Turton, who treated himself with a bunch of hook worms and his seasonal allergies went away.  So helminths look like a cure for seasonal allergies.  Dr. Parker said that he views it as a cure rather than as a treatment for allergies, because he views it as exercise for the immune system. If your patient has cardiovascular disease and starts exercising, we don’t view that as a treatment even though their disease may have gone away. Helminths have been with vertebrates for approximately 300 million years ago, so they have always been with us and they are something our immune system needs to function normally. 

21:00 I said that I imagine that just like there are good and bad bacteria, that there are good and bad helminths.  I recall Parasitology class and learning about parasitic worms that travel through your body and eat at your liver and your brain and kill you. So when we are talking about using worms, we are talking about certain worms that have a therapeutic value but are benign. Dr. Parker explained that during the agricultural revolution and people started living in crowded conditions and the number of worms per person went way up. If we talk about the porcine tape worm, you have a worm that is bad and it can form a cyst in the brain that would have to be surgically removed. Whereas the rat tape worm is one of the best hopes for getting helminths approved by the FDA.

23:35  I asked is that the TSO worm you are talking about? Dr. Parker answered that the TSO is the porcine whipworm not to be confused with porcine tapeworm.  And then Dr. Parker is working on the rat tapeworm. I then asked about the HDC worm. Dr. Parker explained that the HDC is the therapeutic stage of the rat tapeworm. I then interjected that it is my understanding that these TSO and HDC worms will grow temporarily inside us but then they’ll die. There are are cases with someone who is immuno-compromised that they’ll reproduce in humans, but for most people, you have to keep re-exposing yourself to these worms to maintain a certain level of exercise for the immune system.

26:01 I commented that this is kind of like the next level of probiotic.  Dr. Parker answered that there is one physician who refers to them as premobiotics. He said he’d like to get them approved as a dietary supplement. Unfortunately, it is going to require legislation for that. But he believes that humans in general need worms.  First we will have to treat the desperately ill and prove efficacy and safety. Then we’ll move on to less debilitating patients, such as allergies.

27:57 I asked if IBS is a condition that can respond to worm therapy? Dr. Parker responded that there are some studies using worms successfully with IBS patients. Dr. Parker is concerned that patients will think of helminths as a drug, but helminths should be thought of as part of a healthy diet. Dr. Parker said that there are five deadly factors in our society that are killing us early, which include, 1. bioalteration–the loss of our helminths and protozoans, 2. diet, 3. sedentary lifestyle, 4. chronic stress, including sleep alterations, and 5. vitamin D deficiency. 

29:08 I said that it sounds like worms would be most effective for prevention. With IBS, I believe that most cases are not really stress related but caused by dysbiosis, specifically small intestinal bacterial overgrowth and perhaps the helminths are balancing our microbiota. Dr. Parker said that studies they have done show profound changes to the microbiota when we put in a helminth. There is a change of up to 20% of the microbes, including ones that are associated with less inflammation. When the immune system gets inflamed, that affects the microbiota. I suggested that perhaps these helminths have a similar effect to phages, which are viruses that crowd out certain non-beneficial bacteria. Dr. Parker said that we don’t really know if our bacterial phages have changed since hunter-gatherer times. We don’t view the microbiota as a primary causative agent in disease and we see it more like a victim of what is going on in the body. This has to do with our thinking back in the 80s that the immune system is supporting the microbiota, which was originally ridiculed but is now widely accepted. This is what led us to figure out what the appendix does.

34:01 I said that the next topic I would like to touch on is autism and you (Dr. Parker) have written and talked about how worms can potentially be beneficial for autism and you have also written a paper on how acetaminophen use is associated with increased risk of autism. http://journals.sagepub.com/doi/abs/10.1177/0300060517693423   Dr. Parker answered that the idea of looking at autism was something that came up because many patients with autism are trying helminths, since there are not a lot of effective treatments for it.  When you look at the epidemiology of autism what you see is that it doesn’t match other inflammatory conditions like allergies or appendicitis or MS but yet autism is associated with inflammation and there is some sort of trigger that accelerated the incidence of autism and it corresponds to the increased use of acetaminophen from birth till age 5 or 6 due to stopping the usage of aspirin due to Reye’s Syndrome. We switched over to a drug that had not been tested and shown safe for neural development.

36:32 I interjected that I recently did a podcast with Del Bigtree and he believes that childhood vaccines are a major factor in the rate of autism and he talked about the fact that in 1986 the Vaccine Safety Act was passed that shielded manufacturers of vaccines from all liability.  There is less of a concern from the company side in terms of proving that the vaccines are absolutely as safe as they can, because there are no market forces to hold these companies accountable. There have not been a lot of studies on whether vaccines are associated with an increase in autism, despite what the industry says,    Recently, there was a paper published in April and they looked at kids who were vaccinated versus kids who are unvaccinated. And the kids who were vaccinated had six times the rate of autism and seven times the rate of asthma and allergies. http://www.oatext.com/Pilot-comparative-study-on-the-health-of-vaccinated-and-unvaccinated-6-to-12-year-old-U-S-children.php  It looks like there is some sort of an overlap here between what’s happening with these kids and and some of the stuff that you’re talking about. And when I watched your YouTube video where you were talking about autism being possibly related to Tylenol you were talking about the fact that you have to have an oxidative stress on the body which then when you consume acetaminophen at the same time that is sort of a toxic brew that can lead to damage to the brain.  And one of the things that happens with vaccines is that they add these adjuvents, like aluminum, to get the body to react to the vaccine and I wonder if the combination of these kids being exposed to substances like aluminum, which create oxidative stress, in combination with Tylenol can be one of the underlying factors in this increase in autism.  Dr. Parker pointed out that that study was only done with home schooled kids and parents with kids with autism tend to home school their kids. He explained that any form of oxidative stress and inflammation can be a factor in autism, including obesity. Obesity is a highly inflammatory state and results in a 70% increased risk of autism.  I pointed out that since you can’t go to public school in the US , the only population of unvaccinated kids are in the home schooled population, which is why that study used home schooled kids. Dr. Parker pointed out that when older kids with autism use helminths, it can’t fix their social skills but it may help their digestive problems. Helminths may be helpful as preventative agents prior to the onset of autism to regulate their inflammation by providing exercise for their immune system.  Here is Dr. Parker’s YouTube video on acetominophen as a causative factor in autism:  https://youtu.be/oD_opnk4nxU 

48:30  I asked when he speculates that we’ll have the studies to prove efficacy and helminths will be approved so that they can be used in the US for therapy?  Dr. Parker explained that he believes that the market would be huge and nearly every person could benefit from them, but the financial incentives make it difficult. Studies cost tens of millions of dollars and since helminths are biological agents that cannot be patented so it would be difficult to make your money back. And there was already a porcine study that bombed out that we mentioned earlier. Dr. Parker compared it to the fecal transplant which has yet to be approved except recently only for C-Diff infections and yet it was nailed down in 1958 by a group in Denver. 

 

Dr. William Parker can be reached through the Duke University website, https://medschool.duke.edu/about-us/our-faculty/william-parker

Dr. Ben Weitz is available for nutrition consultations and he specializes in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure by calling the office 310-395-3111.

 

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