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Celiac Patients Tolerate Wheat Spaghetti After Hookworm Treatment

Celiac.com 10/03/2014 - Celiac disease patients in Australia have shown a major improvement in gluten tolerance after receiving experimental hookworm treatments. The study is part of an effort to determine if parasitic helminths, such as hookworm, might help to treat inflammatory disorders, including celiac disease.

Photo: Nnaluci--Wikimedia CommonsIn this case, the research team assessed the influence of experimental hookworm infection on the predicted outcomes of three escalating gluten challenges in volunteers with confirmed celiac disease.

The research team included John Croese, MD, Paul Giacomin, PhD, Severine Navarro, PhD, Andrew Clouston, MD, Leisa McCann, RN, Annette Dougall, PhD, Ivana Ferreira, BSc, Atik Susianto, MD, Peter O'Rourke, PhD, Mariko Howlett, MD, James McCarthy, MD, Christian Engwerda, PhD, Dianne Jones, BHSc, and Alex Loukas, PhD.

They are variously affiliated with the Department of Gastroenterology and Hepatology at The Prince Charles Hospital, Brisbane, Australia, the Center for Biodiscovery and Molecular Development of Therapeutics at the Australian Institute of Tropical Health and Medicine of James Cook University in Cairns, Australia, Envoi Specialist Pathologists in Brisbane, Australia, QIMR Berghofer Medical Research Institute in Brisbane, Australia, the Royal Brisbane and Women's Hospital, and with Logan Hospital, Brisbane, Australia.

This particular study followed twelve adult volunteers with diet-managed celiac disease. The volunteers were inoculated with 20 Necator americanus (hookworm) larvae, and then consumed increasing amounts of gluten in the form of spaghetti.

The volunteers first received 10 to 50 milligrams for 12 weeks (microchallenge); they then received 25 milligrams daily + 1 gram twice weekly for 12 weeks (GC-1g); and finally 3 grams daily (60-75 straws of spaghetti) for 2 weeks (GC-3g).

The subjects were then evaluated for symptomatic, serologic, and histological outcomes of gluten toxicity. They were also examined for regulatory and inflammatory T cell populations in blood and mucosa. Two gluten-intolerant subjects withdrew after micro-challenge. Ten completed GC-1g, and eight of these ten volunteers enrolled in and completed the full course of the study.

Most celiacs who are exposed to gluten challenge will show adverse changes in the intestinal villi, which is measured in terms of villous height-to-crypt depth ratios. Also, such patients will usually show an increase in blood antibodies, such as IgA-tissue transglutaminase, indiucating an adverse reaction to gluten. However, the results here showed that median villous height-to-crypt depth ratios (2.60-2.63; P = .98) did not decrease as predicted after GC-1g. Moreover, mean IgA-tissue transglutaminase titers declined, contrary to the predicted rise after GC-3g.

Other results showed that quality of life scores improved (46.3-40.6; P = .05); while celiac symptom indices (24.3-24.3; P = .53), intra-epithelial lymphocyte percentages (32.5-35.0; P = .47), and Marsh scores remained unchanged by gluten challenge.

Intestinal T cells expressing IFNγ were reduced following hookworm infection (23.9%-11.5%; P = .04), with corresponding increases in CD4+ Foxp3+ regulatory T cells (0.19%-1.12%; P = .001).

Hookworms in the form of Necator americanus promoted tolerance and stabilized, or improved, all tested measures of gluten toxicity in volunteers with celiac disease. So, after being voluntarily infected with 20 hookworms, these celiac disease volunteers were able to eat increasingly large amounts of gluten with none of the usual changes or adverse symptoms.

Could hookworm treatments represent the future of treatment for celiac disease, and maybe other inflammatory conditions? Clearly, further tests are needed to determine exactly how safe it is for celiac patients receiving this treatment to eat gluten. So far, however, the future looks bright.

What do you think? If swallowing a small dose of hookworms would eliminate your adverse reactions, and allow you to safely eat gluten, would you do it?

The radio program Radiolab has an interesting segment on hookworm, which you can stream here: Radiolab

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43 Responses:

 
Susie
Rating: ratingfullratingfullratingemptyratingemptyratingempty Unrated
said this on
06 Oct 2014 7:51:23 AM PST
Who wants hookworms living inside them? Sounds utterly grotesque! Maybe I missed something, but was there any mention of how long the hookworms squirm around in your intestines or side effects from them? Since a few dropped out of the study, I will take a guess that they became very ill from gluten exposure. I will take another guess that they are more sensitive to gluten than the other subjects and possibly have other intolerance as well. Lastly, since I was symptomatic from birth and I didn't have "problems" every day of my life until diagnosis (40+years) add in the "reliability factor" of testing (very poor) is it possible that the subjects that remained in the program in its entirety were actually still sick and worsening from their exposure but just don't realize it yet?

 
Jefferson
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said this on
11 Oct 2014 1:47:05 PM PST
Are hookworms any more disgusting than the thousands of bacteria in your gut? Side effects of small numbers of hookworm in the gut are minimal. Anemia is the only side effect, and then, only with large numbers of hookworms. Having 10-20 hookworms in the gut is essentially harmless. The benefits include the elimination of adverse gut reactions to gluten in celiac disease patients.

 
Diane
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said this on
12 Oct 2014 7:21:13 PM PST
I can find anything I want to eat in a gluten free form so what would be the reason for this drastic method? I think they would be with you forever if you don't take something to kill them off. Why subject the poor worms to death just to eat gluten? Sounds weird and not very safe.

 
Michael
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said this on
06 Oct 2014 9:14:09 AM PST
This pretty much defines, demonstrates and proves the practice of eating wheat is an addiction and an obsession, as does 50 to 60 different names for that many shapes of pasta.

 
Diane
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said this on
12 Oct 2014 7:24:01 PM PST
Right on Michael. It is an addiction to wheat and we can find gluten free pasta if we wanted some pasta. Shows drastic measures are attractive alternatives to those truly addicted to wheat??? Not for me.

 
Luann
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said this on
06 Oct 2014 10:16:01 AM PST
Interesting. Although I would do just about anything to eat gluten, this sounds a little gross!

 
Diane
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said this on
12 Oct 2014 7:18:06 PM PST
Most anything you want can be found in a gluten free form so why do something gross like this? Only helps wheat farmers and doctors. I want to be gluten free rather than do this.

 
Diane
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said this on
12 Oct 2014 7:30:26 PM PST
Remember how long it takes to get gluten out of your system? Why take a chance on doing that again? I just made gluten free cookies and brownies today and never have a problem finding gluten free alternatives.

 
Aims
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said this on
06 Oct 2014 10:42:13 AM PST
I don't know about the swallowing - I might prefer to be injected....

However - after more than twenty years of being a confirmed celiac, I have become accustomed to this lifestyle and taste of gluten-free. I actually prefer to be gluten free now.

I guess the costs might help persuade some of the masses of celiacs, and to be alleviated from some of the other side-affects of being a celiac is surely high on the scale of choice. However, my lifestyle has kept me from that for many years.

Yet - there is that small tickling doubt that would say yes. I would like to be able to make a choice whenever I wanted.

And if the small wigglers could also alleviate other inflammatory conditions I certainly would be all for it - just give me some mind-blockers so I wouldn't think about them in my body doing their thing!

 
amie
Rating: ratingfullratingemptyratingemptyratingemptyratingempty Unrated
said this on
06 Oct 2014 11:56:07 AM PST
Heck no the worms could make us have something else we didn't want! Nope won't do it!

 
Jefferson
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said this on
11 Oct 2014 1:42:56 PM PST
The only negative side effect of hookworm is anemia. That only occurs if there are a large amount of hookworms in the gut. Anemia is slow to develop, easy to spot and easy to cure. Hookworms are easily eliminated by simple prescription drugs. Then, if desired, they can be reintroduced as desired.

 
Ron
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said this on
06 Oct 2014 1:32:08 PM PST
Sign me right up. But instead of spaghetti, can I be tested on Bass Ale and pizza?

 
Diane
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said this on
12 Oct 2014 7:15:24 PM PST
I would not ingest any worms to be able to eat wheat. Who does that help? Wheat farmers and doctors? I like my gluten free pizza, pasta, etc. There is good gluten free beer too. Ever see the movie Alien? Don't want aliens inside me.

 
Andrea
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said this on
06 Oct 2014 2:18:58 PM PST
The article was interesting but the study has a fatal flaw. There are two variables working here. One the hookworm, and other the incremental addition of gluten to the subjects. Since there is such a great variation among those of us with celiac Disease as to our degrees of sensitivity, there is also no way to know if some of the subjects could tolerate the gluten because of the gradual increase in amounts of gluten. This gradual increasing in the amounts of gluten is similar to allergy desensitizing. Possibly some subjects improved because of a simple gradual increase in tolerance. The study implies that the hookworms saved the day, probably by consuming the gluten themselves.When people are infected with any parasites, their absorbion of nutrients goes down. Why would any intelligent person want to infect themselves in order to eat something that they already know is so bad for them? There is so much available in the way of whole foods to thrive on. I for one am grateful for the diagnosis. Aside from celiac disease, gluten causes a host of other problems. I'm glad it is out of my diet.

 
Jefferson
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said this on
11 Oct 2014 1:50:39 PM PST
Wheat and gluten are not "bad" for people who do not have celiac disease. In this case, the hookworm is eliminating both the adverse reaction in people with celiac disease, and the inflammation in the gut. Hookworm may be useful in the treatment of many inflammatory conditions, including heart disease, diabetes, etc. Stay tuned.

 
Diane
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said this on
12 Oct 2014 7:28:12 PM PST
I'm with you. My daughter and I have different symptoms to celiac and her symptoms are immediate and mine take longer to manifest so those thinking they have no symptoms just might have my condition where it takes longer to show. Does not sound safe to me.

 
Craig
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said this on
06 Oct 2014 2:48:08 PM PST
Interesting article to say the least. Besides everything that everybody commented on above what about absorption of critical nutrients over the long-term? I can't imagine that the hookworms wouldn't consume all valuable nutrients as well.
I would say that is nice in a pinch if somebody had to consume gluten for a situation that arose such as a wedding or traveling to a different country but this sounds a little ridiculous to me.

 
Janice
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said this on
06 Oct 2014 4:22:01 PM PST
Hook worms can kill you. No thanks.

 
Jefferson
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said this on
15 Oct 2014 12:11:21 PM PST
Hookworms cannot kill humans. The only negative side effect of hookworm is anemia. That only occurs if there are a large amount of hookworms in the gut. Anemia is slow to develop, easy to spot and easy to cure. In places where there is no access to medical care, anemia can be life threatening, but that is extremely unlikely in a western medical setting.

 
Yvette
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said this on
06 Oct 2014 5:50:24 PM PST
If this could cure my Hashimoto's I would seriously consider doing this.

 
Diane
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said this on
12 Oct 2014 7:35:06 PM PST
I have Hashimoto and would never dream of doing this just to eat gluten. This only helps wheat farmers sell more wheat and doctors to do more procedures that might not work. There are so many alternatives that are gluten free. I find the food I make at home better than the restaurants serve so I now don't miss eating out. I take food with me to parties so I can eat my own food but it looks like and is great food for anyone--just gluten free. This worm procedure can cause a whole new set of problems. Want to go through healing again?

 
Craig
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said this on
06 Oct 2014 7:10:28 PM PST
This is as dumb as dirt. Are people so desperate to eat gluten? I've lived healthy for over 18 years being diagnosed as a celiac and very happy to have proactively gained a food education to learn to stay away from garbage in the food supply including wheat in USA. People common.

 
Diane
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said this on
12 Oct 2014 7:37:20 PM PST
Thanks for your intelligent comments. I agree with you and have had no problem converting any recipe to gluten free so I never feel deprived. I guess you have no problem either. Take care!!

 
Darrell
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said this on
06 Oct 2014 7:35:28 PM PST
I also have become accustomed to a gluten free diet. But I would do this in a heart beat because I am a 5 parts per Million type and am constantly being contaminated. I would so welcome my face, hands and stomach being free from inflammation and the mad dashes to the toilet, along with the cramps being a thing of the past. YES, I would eat a lot of worms if it will work. Its all just protein anyway and Simba ate grubs?

 
Diane
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said this on
12 Oct 2014 7:41:12 PM PST
I feel bad that you have had so many problems. I had allergy testing and found many more things I am allergic to and stopped eating them and feel so much better. My daughter has different allergies and has felt better eliminating those from her diet. Good luck finding your ideal diet.

 
Trev
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said this on
06 Oct 2014 8:13:04 PM PST
Absolutely, I would do this. I'd actually stay gluten free, but to guard against cross contamination, for sure. I've had three airborne glutenings in the last year, two in grocery stores where I was not near the bakery or flour aisle, one in a building where drywall was being used unbeknownst to me in another part of the building. Day to day life is dangerous for me right now, and if this makes it less so, give me a plate of hookworms, or anything!

 
Diane
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said this on
12 Oct 2014 7:48:07 PM PST
I am not as sensitive as you are but I did walk into a store one day and choked on the air as they were cooking toast--I guess a lot of it. I try to stay away from bread isles. I didn't know drywall dust could be a problem. Thanks for the info. Take care and get better. I truly don't see how adding worms would help. My allergist found I am allergic to many more things so you might want to check for any other cause for your problems. Did wonders for me. Take care.

 
Susie
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said this on
13 Oct 2014 12:53:24 PM PST
Drywall? Can you please elaborate on drywall. We are about to begin removing the plaster walls in our 1840 home and replace them with drywall. Now you have me a bit worried. I am a 0 ppm celiac, I get sick like you from airborne glutenings. I also get the dermatitis (something the so-called experts say you don't get if you have the intestinal issues, wrong!) from airborne and contact glutenings.

 
Valeria
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said this on
07 Oct 2014 12:38:51 AM PST
Never in my life I will swallow:
(1) gluten
(2) worms

 
Amy Sutherland
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said this on
07 Oct 2014 5:03:06 AM PST
First of all, ewww! I try to be open minded, but this one is stretching my limits. Secondly, I want to know what the hookworms are doing that prevents the usual response to gluten. What is it about hookworms that made the scientists think of them in the first place? And why is it that normally if one gets hookworms, doctors treat them for it? Do they have negative consequences? And lastly, I assume that the little beggars are going to reproduce. How many would one have residing in one's gut? This article needs lots more explanation.

 
Jacquie
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said this on
07 Oct 2014 6:00:53 AM PST
I definitely would not follow the hookworm practice. I would rather go without gluten than swallow or be injected with hookworms

 
Claire
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said this on
07 Oct 2014 7:26:53 AM PST
Do you know the life cycle of the hookworm? The larvae burrow through the skin and enter the bloodstream. From there, they travel to the lungs -- which causes the host to cough them up and swallow them, resulting in an infestation of the bowels. It is my understanding that they sometimes travel the wrong way and end up in the brain. Yes, swallowing them is disgusting, but it might mitigate the risk of a parasite with poor direction. That being said, there has to be a better way.

 
Diane
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said this on
12 Oct 2014 7:52:49 PM PST
Thanks for the info. I should have read up on hook worms but I never thought of doing anything like taking them anyway. Sounds like doctors using us for experiments which do not sound like they will work. Gluten free is not bad as you can find almost anything can be converted to a gluten-free version. Good luck with handling gluten free living.

 
Christine
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said this on
07 Oct 2014 8:07:41 AM PST
I'm sorry, but 12 participants isn't big enough a sample population to warrant relevant results. Besides, hookworms cause other diseases (they don't call those little bastards "parasites" for nothing. I read that they cause intestinal bleeding. I have enough of a damaged intestine from Endometriosis. I don't want any more.

 
mgrant7209
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said this on
07 Oct 2014 8:34:55 AM PST
I have had hookworm infections as a child. I remember the side effects of that - no thank you. I am used to a gluten-free life style now. No amount of tasty pasta, or bread, or pizza, would be worth having worms to me. Who the hell thinks up these idiotic studies?

 
Lisa
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said this on
08 Oct 2014 4:10:35 PM PST
Hmmm ... if they are gummie worms sign me up.

 
Deb
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said this on
08 Oct 2014 5:57:55 PM PST
I think that people should seriously look into this a little deeper. Check out what hookworms can do. They can cause serious intestinal issues and anemia that can lead to heart failure among other things. It may be difficult being GF, but is it really worth the damage you could do? ---The rating above is only rating the quality of the writing and information provided not in support of the ideas of the materials

 
Hansen
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said this on
09 Oct 2014 3:28:45 PM PST
Based on additional readings NO: If you have a hookworm infection that lasts a long time, you could become anemic. Anemia is characterized by a low red blood cell count, which can lead to heart failure in severe cases. Anemia results from hookworms feeding on your blood. You’re more at risk of having severe anemia if you also don’t eat well, are pregnant, or have malaria.

Other complications that can develop from these infections include nutritional deficiencies and a condition known as ascites. This condition is caused by serious protein loss and results in fluid buildup in your abdomen.

Children who have frequent hookworm infections can experience slow growth and mental development from losing a lot of iron and protein.

 
Lawrence

said this on
01 Nov 2014 6:49:43 AM PST
It is no surprise that we don't have a cure for this by now. Every time an article shows up about a possible way to help people with CD eat gluten again everybody comments how they would never in a million years try it. Gluten is evil and they love GF food. You never see this with people who cannot eat peanut butter, shellfish, or any of the other million disorders out there.

 
Jefferson
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said this on
08 Dec 2014 3:52:41 PM PST
An excellent point.

 
Phyllis
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said this on
01 Jan 2015 5:19:27 PM PST
Gross. I would never want hookworms OR gluten in my gut! I hate gluten and have NO desire to eat it, or even be around it. Gluten IS evil. It is not even good for you. I LOVE my gluten free food. And hookworms....really?! GROSS!

 
Scott
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said this on
24 Apr 2015 2:06:36 PM PST
My instant reaction is that it is not worth eating gluten in order to swallow something that my have unknown consequences. The only benefit would be to alleviate cross contamination and be able to eat out with more ease. My question is that there had to be some information to make the doctors think in the first place that hookworms would help with celiac. What could they have previously discovered that would merit this study?

 
Andrew
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said this on
24 Aug 2016 1:25:46 PM PST
As someone who gets sick fairly regularly on a gluten free diet due to cross contamination and other trace gluten, I would love to be in a hookworm study just to not get sick.




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