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  • Jefferson Adams

    Celiac Patients Tolerate Wheat Spaghetti After Hookworm Treatment

    Jefferson Adams
    Reviewed and edited by a celiac disease expert.

    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.

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    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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    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?

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    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.

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    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!


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    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.

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    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.

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    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.

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    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?

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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