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Have Celiac Disease? Try a Little Hookworm with that Pasta!

Journal of Gluten Sensitivity Autumn Issue - Originally published October 7, 2014

Photo: CC--SuSanA Secretariat

Celiac.com 07/26/2016 - What a gross title–it bothers me and I wrote it! It wasn't my idea originally. The research paper the data came from was entitled, "Experimental hookworm infection and gluten microchallenge promote tolerance in celiac disease" published recently in the Journal of Allergy and Clinical Immunology.

It might be gross but the results were pretty darn interesting. Now don't try this at home, needless to say, but let's look at what these professional researchers discovered.

The hookworm, also known as a parasitic helminth, is known to have beneficial effects in inflammatory disorders. Therefore the researchers decided to see what would occur if they induced a hookworm infection into known celiacs and fed them escalating amounts of gluten.

A one year study was embarked upon with 12 consenting adults. They were given the hookworm larvae (Necator americanus–glad to know it was an "American" hookworm–joke) and increasing amounts of gluten, consumed as pasta were administered.

The initial microchallenge consisted of a small 10 to 50 mg for 12 weeks, followed by 1 gram plus 25 mg given twice per week for an additional 12 weeks, and finally 3 grams daily, the equivalent of 60-75 straws of spaghetti, for 2 weeks.

Symptoms, blood and tissue specimens from the small intestine were all utilized to ascertain gluten toxicity.

The results were surprising even to the researchers. While two of the subjects withdrew after the initial microchallenge, the remaining 10 completed the next 1 gram phase with the final 8 completing the entire process and ingesting 3 grams of gluten daily.

Lab results revealed no decrease in villi height, something one would suspect in a classic celiac who ingested gluten. The classic blood test that reveals damage occurring to the lining of the intestine, tTG did not rise, as expected, but levels actually declined, despite the 3 gram intake of gluten. A quality of life questionnaire showed improved quality of life scores, while a celiac symptom index, level of inflammation of the gut and Marsh scores evaluating degree of damage to the lining of the intestine were all unchanged.

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Additionally a substance known as interferon gamma that is produced by immune fighting cells was reduced following the hookworm infection, illustrating that the hookworm somehow caused the immune system to not "react" to the ingestion of gluten. Another group of immune cells called regulatory T cells increased, further supporting the theory that the immune system did not in any way react to the presence of the ingested gluten despite the patients having celiac disease.

The researchers' conclusions were that our new best friend, hookworm Necator Americanus, promoted tolerance while stabilizing or improving all the gluten toxicity indexes evaluated in these 8 patients.

Fascinating, isn't it? There are several questions that come to my mind that I would like answered:
Are there any downsides to having a hookworm infection?
If not, and the upsides are decreased inflammation and tolerance to gluten, how do we know if we have enough hookworms to get these benefits?
Are the benefits local but not systemic? In other words we know that gluten can create problems in distant organs and systems. Does the hookworm infection successfully address these problems or not?
If one has a leaky gut, for instance, does the hookworm infection help the condition?
Is the hookworm a friendly beast that is designed to cohabitate in our guts, or will it naturally rid itself from our body if not reinocculated?

There's obviously more we need to know about this, but I wanted to share this information. We should remember that our gut houses trillions of organisms that we call our microbiome or probiotic population, therefore it is not a "stretch" to consider that the presence of organisms in the gut is something that could be quite healthy and normal.

Personally I like this idea far better than taking a drug with the ever-present side effects associated with putting a foreign substance in the body.

While we are deciding if this little beast will be part of our population of friendly organisms and potentially solve our reactions to gluten, please let me know if there's any assistance you need in improving your health. Whether you have celiac disease, gluten sensitivity or some other issue that is continuing to compromise your health, consider contacting us for a FREE health analysis – call 408-733-0400.

We are a destination clinic and we treat patients from across the country and internationally. We are here to help. I look forward to hearing from you!


  • Journal of Allergy and Clinical Immunology, "Experimental hookworm infection and gluten microchallenge promote tolerance in celiac disease". Published Online: September 20, 2014. DOI: http://dx.doi.org/10.1016/j.jaci.2014.07.022

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10 Sep 2016 6:29:39 PM PDT
I would be concerned about visceral larval migrans, where intestinal parasites migrate outside the gut and into the rest of the body. This is a known potential complication of hookworm infections in the field of public health. I would like to know the risk of this potential complication with this treatment. I would assume that it is not recommended for children as they are more susceptible to visceral larval migrans.

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So just to clarify had not consumed any gluten for about 4 days before testing. I was assured by my allergist that it wouldn't affect the test. But what was alarming was that she retested my food allergies (my most recent reaction was two weeks ago) and every food allergy I have came back negative. I don't understand how that is possible. These food allergies developed when I was 20 and I am almost 24 now.

Thanks! You too! I have learned from this experience to take charge of my own health. It's nice at least that we can try the gluten-free treatment without a firm diagnosis or a doctor confirming the disease. I've also felt some of the gluten withdrawal symptoms, and my stomach pain ebbs and flows, but I'm determined to stick with the gluten-free diet to see what a difference it makes. Gemini, thank you! This was really validating and useful for me to hear. I've felt so confused through this process and just want some answers. If the biopsy results do come back negative, I'm going to follow your advice and do the gluten-free diet with repeat blood testing after a while. If they come back positive, well, then I'll have my answer. I'm supposed to get them back next week.

I have celiac and eosinaphalic esophagitis. I was put on a steroid inhaler recently. I use it like an inhaler but swallow the air instead of breathing it in. You may want to look into EOE and it's relationship to celiac. Just a thought. My swallowing and celiac seem to be related.

You have eat gluten every single day until after testing. And the celiac blood test is supposed to be done as well.

If I was the big guy, there's no way I would have to wait 3 and a half weeks for a test lol. My GI doc never recommended the antibody test. He said doing it with the scope was the only sure way to know. Does anybody know if I should eat a little gluten the day before my test to see if I will get an accurate enough test? Or will it not matter, once the damage is done it's done?