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    Jefferson Adams
    Jefferson Adams

    Celiac Patients Tolerate Wheat Spaghetti After Hookworm Treatment

    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: Open Original Shared Link

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    Guest Jefferson

    Posted

    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.

    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.

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    Guest Diane
    Sign me right up. But instead of spaghetti, can I be tested on Bass Ale and pizza?

    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.

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    Guest Diane
    Interesting. Although I would do just about anything to eat gluten, this sounds a little gross!

    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.

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    Guest Diane
    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?

    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.

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    Guest Diane
    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.

    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.

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    Guest Diane
    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.

    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.

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    Guest Diane
    Interesting. Although I would do just about anything to eat gluten, this sounds a little gross!

    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.

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    Guest Diane
    If this could cure my Hashimoto's I would seriously consider doing this.

    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?

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    Guest Diane
    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.

    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!!

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    Guest Diane
    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?

    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.

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    Guest Diane
    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!

    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.

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    Guest Diane
    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.

    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.

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  • About Me

    Jefferson Adams

    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. His articles, essays, poems, stories and book reviews have appeared in numerous magazines, journals, and websites, including North American Project, Antioch Review, Caliban, Mississippi Review, Slate, and more. He is the author of more than 2,500 articles on celiac disease. His university coursework includes studies in science, scientific methodology, biology, anatomy, physiology, medicine, logic, and advanced research. He previously devised health and medical content for Colgate, Dove, Pfizer, Sharecare, Walgreens, and more. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of numerous books, including "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

    >VIEW ALL ARTICLES BY JEFFERSON ADAMS

     


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