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Celiac.com 01/13/2023 - Celiac disease is an autoimmune disorder in which gluten consumption triggers gut damage. The only effective treatment is a strict gluten-free diet. Can hookworms help celiacs eat gluten? The answer is yes and no, coupled with some trade-offs. Here's the rundown. Earlier studies have indicated that hookworm infection may restore some level of gluten tolerance in celiac patients, however, none of these approximately one dozen studies were placebo controlled. We've done a number of articles on hookworms and celiac disease. We've even done an article on health claims from at least one hookworm-infected celiac patient who claimed he was able to safely eat gluten. Can Hookworms Help Celiacs Eat Gluten? To get a more detailed answer, a research team recently undertook a randomized, placebo-controlled trial of hookworm infection in nearly sixty people with celiac disease. The team included John Croese, MD; Gregory C. Miller, FRCPA; Louise Marquart, PhD; Stacey Llewellyn, BSc; Rohit Gupta, FRACP; Luke Becker, BAppSci; Andrew D. Clouston, PhD; Christine Welch, FRACP; Julia Sidorenko, PhD; Leanne Wallace, BSc; Peter M. Visscher, PhD; Matthew L. Remedios, FRACP; James S. McCarthy, MD; Peter O'Rourke, PhD; Graham Radford-Smith, PhD; Alex Loukas, PhD; Mark Norrie, PhD; John W. Masson, FRACP; Richard B. Gearry, PhD; Tony Rahman, PhD; and Paul R. Giacomin, PhD. They are variously associated with the Department of Gastroenterology and Hepatology at The Prince Charles Hospital in Brisbane, Australia; the Center for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia; the Envoi Specialist Pathologists, Brisbane, Australia; the QIMR Berghofer Medical Research Institute, Brisbane, Australia; the Department of Gastroenterology, Townsville University Hospital, Townsville, Australia; the Institute for Molecular Bioscience at the University of Queensland, Brisbane, Australia; the Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia; the Gastroenterology and Hepatology, Logan Hospital, Brisbane, Australia; and the Department of Medicine, University of Otago, Christchurch and Canterbury District Health Board, Christchurch, New Zealand. Study Ran Nearly Two Years In a study that ran for just under two years, a research team of medical professionals treated celiac patients with with a placebo, or with either third stage larvae of the 20 or 40 Necator americanus hookworm (L3-20 group or L3-40 group). Patients then increased their gluten consumption to 5 grams per day for 12 weeks, 1 gram intermittent twice weekly for 12 weeks, and two grams sustained for six weeks, followed by liberal diet for 1 year. About forty to fifty percent of hookworm patients, and about fifty-five percent of placebo subjects made it to the main outcome point of 42 weeks, and hookworm-treated participants did show a sharp reduction in gluten-related events. Duodenal villous height: crypt depth deteriorated similarly compared with their enrollment values in each group, with an average change of −0.6 for the placebo group; -0.5 for the L3-20 group , −1.1 for the L3-40 group. A retrospective analysis showed that nearly one in four L3-treated participants failed to develop successful hookworm infection. Lower Quality of Life Scores for Hookworm Patients Between forty to fifty percent of participants in each group completed the study, but quality of life symptom scores after the gluten challenge were under forty percent in hookworm-positive participants, compared with over forty-five percent for the hookworm negative group. From their findings, the team concludes that hookworm infection DOES NOT restore gluten tolerance enough to allow sustained moderate consumption of gluten of two grams per day or more. However, hookworm infection did lead to better symptom scores after occasional consumption of lower doses of gluten. The findings undercut the idea that hookworm infection is some kind of magic bullet for gluten consumption for people with celiac disease. Hookworm Infection Not a Magic Bullet for Celiacs At best, the data support the idea that hookworm infection can help reduce symptoms of moderate gluten consumption in people with celiac disease, but that any reduction also likely comes with a lower overall quality of life score. This is the most definitive study we've yet seen on the effects of hookworm infection on the ability of celiac disease patients to tolerate gluten. The results are clear that any modest benefits of hookworm infection comes with some potential reduction in quality of life. Still, the ability of hookworms to help reduce symptoms of moderate gluten consumption in people with celiac disease merits further study. It's possible that hookworms hold some secrets in their biochemistry that might help to offer some extra protection against the inflammation triggered by limited gluten consumption. That is some exciting news. Read more at: Clin Transl Gastroenterol. 2020 Dec; 11(12): e00274.

Celiac.com 12/16/2022 - Recently, an interesting discussion thread popped onto our celiac disease and gluten-free forum. A member of the forum, going by the handle @dixonpete, claims his celiac disease went into remission after treatment with hookworms. Moreover, he claims that he is essentially cured, and able to eat gluten with no side effects, and has had at least one recent negative follow up tTG antibody test to back this up. History of Hookworm Infection to Treat Celiac Disease We've done more than a few articles on the potential to use hookworms to treat celiac disease. We've done a number of articles on hookworms as the potential future of celiac disease treatment, including: Are Intestinal Worms the Future of Autoimmune Disease Treatment? Could Hookworm Infections Help Cure Celiac Disease? Celiac Patients Tolerate Wheat Spaghetti After Hookworm Treatment Have Celiac Disease? Try a Little Hookworm with that Pasta! Previously, we'd only reported data from various studies, some of which looked promising. Until recently we had never heard directly from anyone claiming to have gone through hookworm treatment firsthand. Because he is the first person we've heard from who claims direct experience with hookworm treatment for celiac disease, the information furnished by @dixonpete to the thread might be of interest to anyone who might be interested in the possibility of receiving hookworm treatment. Hookworms seem to work, at least partly, by blocking the inflammatory response in the gut of the host. One of the benefits of this treatment is that the hookworms may also block the gut's immune response to gluten in people with celiac disease. Could Hookworm Treatment Allow Celiacs to Eat Gluten Again? At this time, there's no data to confirm that hookworm treatment "cures" celiac disease in the classic sense of the word. In theory, if the hookworms were eliminated, then the celiac disease could return. And the hookworms don't reproduce, so you need just the right amount in the gut, but not too much. The current hypothesis is that the hookworms simply block the immune inflammatory response when people with celiac disease eat gluten. But even that remains unclear, and not well-supported by data. Clearly more studies need to be done to verify whether hookworms present a viable alternative for people with celiac disease. A single example of this possibly working in real life isn't enough data to support the claim that the treatment should work for all celiacs. In fact, @dixonpete admits himself that he was suffering from both celiac disease and other conditions that drove his decision. Still, it's a compelling story. For more information, read the full discussion thread and the related articles. If hookworms prove to be effective treatment for celiac disease, would you be willing to consider a hookworm infection to treat your celiac disease? Let us know in the comments below.

Celiac.com 06/29/2021 - A scientist has been awarded nearly $2 million to study how venom from parasitic worms, called nematodes, allows them to live undetected in our bodies. He hopes it can lead to new treatments for celiac, and other inflammatory diseases. The fact is that nearly one in four people on earth is infected with parasitic worms called nematodes. According to Wikipedia, nematodes that commonly parasitize humans include ascarids (Ascaris), filarias, hookworms, pinworms (Enterobius), and whipworms (Trichuris trichiura). These tiny worms work their way into our bodies quietly, but some types of these nematode can cause blindness or death. One thing all nematodes have in common is the ability to fool our body into thinking they aren't even there. By releasing a venom that cloaks their presence, nematodes avoid detection by the human body, and then propagate. The venom also suppresses inflammation that would otherwise make the worms' presence known to the body. We've written more than one article on the promise of hookworms and, hookworm venom, in treating inflammatory diseases, like celiac disease. Some of those articles include: Could Hookworm Infections Help Cure Celiac Disease? Celiac Patients Tolerate Wheat Spaghetti After Hookworm Treatment Have Celiac Disease? Try a Little Hookworm with that Pasta! Are Intestinal Worms the Future of Autoimmune Disease Treatment? The subject has also been a popular topic on Celiac.com's gluten-free forums. Because nematodes, including hookworms, are so good at masking their presence, they are often detected only when doctors begin to address some outward symptom caused by their unchecked propagation. Many researchers think that venom from nematodes could help to develop drugs to treat numerous anti-inflammatory conditions. So promising is the idea that the National Institute of Health (NIH) recently awarded parasitologist Adler Dillman $1.8 million to figure out how these worms use their venom to remain undetected in our bodies. Dillman hopes the research could one day help treat autoimmune disorders, including celiac disease. Stay tune for more on exciting, cutting edge developments for celiac disease. Read more at Business Insider

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. 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! Reference: 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