Selecting a therapeutic helminth

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The scientific evidence

There have been no head-to-head clinical trials comparing any of the currently available therapeutic helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], and there may never be any, due to the extremely high cost of mounting such studies and the lack of incentive for anyone to fund them. There is also little scientific evidence for the efficacy of individual helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths].

In the groundbreaking Correale and Farez study of 2007 in patients with multiple sclerosis, [1] all the helminthAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths]-infected subjects benefited, even though they had 5 different species of helminth between them. Therefore the type of worm used may not make a great deal of difference to the outcome of helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy..

The only organism to be studied in the treatment of autoimmune disease in well designed trials at therapeutic doses is TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis, and this has been shown to be safe and effective in ulcerative colitisUlcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset., [2] (PDF) promising in the management of Crohn's diseaseAlso known as regional enteritis, this is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is severe), vomiting or weight loss, but may also cause complications outside the gastrointestinal tract such as skin rashes, arthritis, inflammation of the eye, tiredness and lack of concentration. [3] as well as in the treatment of relapsing-remitting multiple sclerosis (RRMS) [4] and also in dampening allergic airway hyper-reactivity. [5] TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis has also shown significant results in 70% of subjects with the inflammatory subtype of autism spectrum disorder (I-ASD) who took TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis in its original pH2.7 form. [6]

Several other trials of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis were conducted by the now defunct company, Coronado Biosciences, prior to the termination of its research programme early in 2015 following what appeared to be disappointing results. However, the apparent failure of these trials may have been due to poor trial design, including an inadequate duration of only 12 weeks and, in particular, the insistence by researchers on the use of a novel formulation of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis with a higher pH than the product that had been employed successfully in previous studies and used to good effect by self-treaters for more than a decade. [7], [8]

The first trial of the hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., NAthe human hookworm, Necator americanus, to use a realistic dose and duration of colonisation was completed in early 2016 at Nottingham University in subjects with relapsing remitting multiple sclerosis (RRMS), [9] but the results from this trial had not been published when this page was last updated.

There have been no clinical trials in humans using the other available therapeutic organisms, TTOthe ova (eggs) of the human whipworm, Trichuris trichiura and HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta, although there was a detailed case study of an individual with ulcerative colitisUlcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset. who experienced almost complete remission of his symptoms after self-infecting with TTOthe ova (eggs) of the human whipworm, Trichuris trichiura, [10] and a further case study showing several indicators of mucosal and systemic immune modulation following self infection with TTOthe ova (eggs) of the human whipworm, Trichuris trichiura. [11] A study in mice showed that Infection with HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta was superior to daily corticosteroids in the prevention of colitis in this species, and that this did not result in any additional side effects. [12]

The anecdotal evidence

While data from clinical trials is still limited, the anecdotal evidence gathered by the self-treaters who have pioneered helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy. for more than a decade is already significant and compelling. (See Helminthic therapy personal stories and this paper [PDF]) Apart from the study at the second of these links, there is little recorded anecdotal evidence for TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis and HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta, largely because users of these two organisms, and especially TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis, have been much less active on helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy. social media sites. In contrast, NAthe human hookworm, Necator americanus has been discussed extensively online since 2007, and TTOthe ova (eggs) of the human whipworm, Trichuris trichiura since 2009, originally on the Yahoo Helminthic Therapy Forum and, more recently, in the Facebook Helminthic Therapy Support Group.

NAthe human hookworm, Necator americanus (Necator americanusThe species of human hookworm used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.)

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There is perhaps no better example of a therapeutic parasite than the hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., Necator americanusThe species of human hookworm used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.. [13]

NAthe human hookworm, Necator americanus, which has the longest lifespan of the currently available therapeutic helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], produces powerful systemic immunomodulation and it’s use appears to be effective in approximately 70-80% of cases of autoimmune disease, inflammation and allergy. [14] [15] [16] The extent of its benefits can be seen in the hundreds of reports in the compilation of Helminthic therapy personal stories, most of which are from users of NAthe human hookworm, Necator americanus.

This organism causes a short-lived, but often itchy, rash at the inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] site in most subjects, and may produce a very pleasant, if brief, “bounce” (see below) in the first few weeks following inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation], as well as causing other well documented transient side effects during the first few months. (See The hookworm timeline) However, it does not cause any long-term ill effects.

Concern is sometimes expressed about the safety of self-infection with NAthe human hookworm, Necator americanus, and it has been claimed that this species can act as a vector for pathogens and mis-migrate to organs outside the digestive tract, but neither of these claims is true. Nor is anaemia/anemia an issue for the vast majority of well-nourished NAthe human hookworm, Necator americanus hosts, and the “tissue damage” caused by hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. needs to be seen in context. For more detail about all these issues, see The safety of NA.

For more information about NAthe human hookworm, Necator americanus, see the following pages.

TTOthe ova (eggs) of the human whipworm, Trichuris trichiura (Trichuris trichiuraThe human whipworm used in helminthic therapy and taken periodically as microscopic eggs (TTO) in a drink. ova)

The colon-dwelling Trichuris trichiuraThe human whipworm used in helminthic therapy and taken periodically as microscopic eggs (TTO) in a drink., which has an effect that is less systemic than that of NAthe human hookworm, Necator americanus, and more localised in the colon, is most frequently employed in the treatment of ulcerative colitisUlcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset. and colonic Crohn’s disease, with or without the addition of NAthe human hookworm, Necator americanus.

TTthe human whipworm, Trichuris trichiura can cause allergies to flare temporarily, [17] and may cause transient allergic-type reactions in people who normally don’t have allergies. [18] These may include skin reactions or rashes, which typically start a few days after taking the ova and may continue for 3-6 weeks but are usually mild and short-lived. In a few cases, these side effects can persist for longer, even up to 8 weeks after taking TTOthe ova (eggs) of the human whipworm, Trichuris trichiura. [19] The worst recorded allergic reaction to TTthe human whipworm, Trichuris trichiura is described here, but such a severe response is extremely rare.

Some other conditions may flare temporarily after taking TTOthe ova (eggs) of the human whipworm, Trichuris trichiura, including herpes. Someone who already suffers frequent or severe outbreaks of herpes may see these worsen and increase in frequency for up to three months after inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] with TTOthe ova (eggs) of the human whipworm, Trichuris trichiura, [20] before returning to the pattern seen before inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation]. Constipation can be another short-term consequence of adopting human whipwormsA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink.. [21], [22]

In general, any side effects following inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] with TTOthe ova (eggs) of the human whipworm, Trichuris trichiura are likely to be mild, subside quickly, and be easier to cope with than those produced by NAthe human hookworm, Necator americanus.

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I had light side effects with TTOthe ova (eggs) of the human whipworm, Trichuris trichiura. On doses 1-3, I had some diarrhea, but by dose 4, I was diarrhea free. [23]

The side effects following supplementary inoculations with TTOthe ova (eggs) of the human whipworm, Trichuris trichiura typically become less severe with each successive dose but, in a few people taking larger doses, side effects may continue to appear briefly after each new dose in the long term.

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WhipwormsA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. have much less side effects (than hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.), for me, and last a month at the very extreme. I can take a dose of 500 human whipwormA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. and the side effects last a week (5 days). Mostly gut upset then I'm back to my usual self. [24]

There is an extremely small possibility that human whipwormsA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. might cause anaemia (anemia) over time. However, the type of anaemia involved is not due to low iron levels, so cannot be treated by iron supplementation. It has been speculated that this form of anaemia might be due to active suppression of the formation of blood cellular components in the bone marrow, rather than as a result of bleeding. The likelihood of this phenomenon occurring in someone using therapeutic doses of human whipwormA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. is thought to be vanishingly small, and, if it were to occur, it may - according to one physician member of the helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy. community - be amenable to remediation by taking Erythropoietin (EPO).

In spite of the eventualities mentioned above that may follow inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] with TTOthe ova (eggs) of the human whipworm, Trichuris trichiura, the potential benefits of hosting the human whipwormA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. are such that it can be well worth persisting with. [25], [26], [27] If necessary, NAthe human hookworm, Necator americanus can be hosted in addition to TTthe human whipworm, Trichuris trichiura in order to reduce the possibility of an allergic reaction to the latter and to provide additional systemic inflammation control. [28]

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The TTOthe ova (eggs) of the human whipworm, Trichuris trichiura I think help my colonic issues the most and the NAthe human hookworm, Necator americanus help with some of the systemic/allergic issues I've had and my overall mood (they help me feel relaxed and often euphoric). [29]

Most people with ulcerative colitisUlcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset. seem to do best using TTOthe ova (eggs) of the human whipworm, Trichuris trichiura, either alone, or with NAthe human hookworm, Necator americanus, while there are others who have had success using NAthe human hookworm, Necator americanus alone, or NAthe human hookworm, Necator americanus supported by TTOthe ova (eggs) of the human whipworm, Trichuris trichiura.

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I'm someone with UCUlcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset., and NAthe human hookworm, Necator americanus keeps me in remission. For some people, TTOthe ova (eggs) of the human whipworm, Trichuris trichiura is way better, but I think the NAthe human hookworm, Necator americanus is doing the magic for me. [30]
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I have Crohn's in my large intestine but for whatever reason NAthe human hookworm, Necator americanus seems to do most of the heavy lifting for treating my disease. However the TTOthe ova (eggs) of the human whipworm, Trichuris trichiura does help. [31]

A few people have felt less well after adding NAthe human hookworm, Necator americanus on top of TTOthe ova (eggs) of the human whipworm, Trichuris trichiura, and a few others have reported being less well after adding TTOthe ova (eggs) of the human whipworm, Trichuris trichiura to an existing colony of NAthe human hookworm, Necator americanus. [32]

It has occasionally been suggested that TTthe human whipworm, Trichuris trichiura might be able to multiply within a host, but this is not the case since the eggs of the human whipwormA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. need to be deposited in soil, where, given suitable conditions, they will embryonate after two to three weeks. It is only at this point that they become infective so, unless a user of TTthe human whipworm, Trichuris trichiura ingests further embryonated eggs, their colony will not increase.

TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis (Trichuris suisThe porcine (pig) whipworm used in helminthic therapy and taken as microscopic eggs (TSO) in a drink every two weeks. ova)

TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis has a localised effect in the colon [33] similar to that of TTOthe ova (eggs) of the human whipworm, Trichuris trichiura, so is particularly effective in the treatment of diseases affecting this section of the intestine, such as ulcerative colitisUlcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset.. It has also proved to be effective against autoimmune disorders affecting other parts of the body, especially Lupus and Crohn’s disease [34] but may not be as effective against MSMultiple sclerosis (also known as disseminated sclerosis) is a chronic, typically progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord, whose symptoms may include numbness, impairment of speech and of muscular coordination, blurred vision and severe fatigue. as NAthe human hookworm, Necator americanus. [35] TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis can also be effective in autism, [36][37][38] perhaps more so than any of the other worms, [39] although the extent of its effect is dependent on the sub-type of autism exhibited, [40] and NAthe human hookworm, Necator americanus is reportedly helpful in addressing some of the medical co-morbidities that accompany autism. [41] TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis has been reported to efficiently dampen allergic airway hyper-reactivity [42] and has been claimed to be very effective in the treatment of food and contact allergies, [43] although less effective than NAthe human hookworm, Necator americanus against seasonal allergies.

As with other helminth species, TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis may cause transient side effects when first introduced, especially, but not limited to, minor gastrointestinal problems and mild spasms.

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TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis caused me a few days of looser stools and a rumbling gut, then it settled down around the 4 to 5 day mark. [44]
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So, tomorrow I take dose 2 of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis... My chronic sinus/eustachian issues seem to be flaring. [45]

In some people, temporary mild side effects may continue to be experienced following all doses in the long term.

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I feel fine after 3 days of gut upset. [46]

Approximately 80% of people who take at least one full course of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis (10 doses, one of which is taken every 2 weeks) may achieve disease remission and, according to the producer of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis, around 60% of these subjects will continue to experience remission for between 1 and 3 years. This was demonstrated by the experience of one TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis user.

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I finished taking them in mid 2013 and am seeing the effects starting to wear off now (late 2015), so the 10 doses appear to last for about 2 years.[47]

During this time, some users of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis may not need any further doses at all, while others might need to take a periodic maintenance dose, for example 500 TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis every 2 months. [48] This has allowed some subjects to maintain remission for many years, although the level of success is likely to depend on the severity of a subject’s condition at the start of treatment. One individual with ulcerative colitisUlcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset. has reported being in remission for 9 years after taking a single course of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis during a clinical trial.

There are, however, some users of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis who do not continue to experience benefit after completing a course of 10 doses.

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I did not go into remission though with 10 doses of 2500 TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis. [49]

These individuals may need to maintain the treatment long-term.

For more information about TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis, see the following page.

HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta (Hymenolepis diminutaA murine (rat) tapeworm used in helminthic therapy that generally does not mature in humans and is taken as cysticerci (HDC) in a drink every 2 or 3 weeks. cysticercoids)

While anecdotal evidence about this latest addition to the list of therapeutic organisms is still limited in comparison with that available for NAthe human hookworm, Necator americanus and TTthe human whipworm, Trichuris trichiura, posts to the helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy. groups indicate that the HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta experience follows a similar course to that seen with other helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], beginning with the possibility of initial transient side effects and leading to eventual success in many cases.

As with the other therapeutic helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta can cause initial side effects, some of which have been found to be quite challenging by a few users.

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HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta does not have less side effects for everyone, it caused me a huge amount of discomfort. [50]

And it has been reported that approximately 1% of paediatric patients may experience severe gastrointestinal pains with the use of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta, although these symptoms are resolved by the administration of an anthelminthic drug. [51]

A number of successes have been reported by HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta users, e.g.,

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… my hay fever has been much better on HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta. Barely noticed it this year. [52]

as well as some failures, e.g.,

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… I’m on HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta and they do not seem to help with food reactions sadly, i was ready to run for a 1kg bar of chocolate in the name of science!

There are reports from subjects who have previously used NAthe human hookworm, Necator americanus that the effects of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta can be more gentle and subtle than those produced by hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin..

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HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta seemed gentler / more subtle all around than NAthe human hookworm, Necator americanus

but others have obtained more relief after adding, or switching to, NAthe human hookworm, Necator americanus.

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After I’d been taking HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta for a while and established that there is no extra benefit for me in hosting HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta as well as NAthe human hookworm, Necator americanus, I killed off the hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin. to see what the HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta could do on their own. Unfortunately, nasal congestion returned within 48 hours of terminating the NAthe human hookworm, Necator americanus, and this persisted to such an extent that, after 5 weeks, I was desperate to restock with hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.. Within two days of taking a dose of 40 HWhookworm, usually referring to the human hookworm, Necator americanus larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state., the congestion receded. In the weeks that followed, I experienced symptoms that are typical after inoculating with NAthe human hookworm, Necator americanus, indicating that the HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta, which I had continued to take, were not effectively modifying my immune response to the new NAthe human hookworm, Necator americanus.

HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta users frequently report a welcome elevation in mood, especially in the first few days after inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation].

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I like how it (HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta) puts me in a good mood for a day or two when I first take it.

However, HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta can also have an adverse effect on mood.

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The response I had from the HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta was sweating, feeling sick but it was also especially agitation and depression. [53]

As larger numbers have begun using HDCsthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta, more reports of adverse side effects have emerged. These have revealed transient problems very similar to those seen with hookwormsA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin., but have also included reports of a need for larger doses once the “honeymoon period” of the first 6 months is over, and continuing into the long term.

The fact that a fresh dose of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta needs to be taken every two weeks, coupled with their very short shelf life, means that maintaining a regular dosing schedule can be an issue with this species.

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I did once miss a dose for 30 days, and there was hell to pay on that account. My immune system went crazy for about a week, until I could get a new dose. [54]

More examples of users’ experience with HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta can be found in The HDC experience.

In June 2016, a researcher at Duke University commented that William Parker’s team had been unable to determine much difference between the effect of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta and TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis. [55]

For more information about HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta, see the following pages.

Comparing human helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] with non-human helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths]

NAthe human hookworm, Necator americanus and TTthe human whipworm, Trichuris trichiura have both become very well adapted to living in humans during millions of years of cohabitation and coevolution with mankind. This longstanding relationship allows them to grow to maturity in the human gut and enter into an on-going, dynamic, two-way chemical dialogue with their host’s immune system. The resulting immune modulation prevents the worms from being overwhelmed, and provides their host with benefits that are maintained for as long as the worms survive.

The survival of human helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] depends to a large extent on the vigour of the host’s immune response. NAthe human hookworm, Necator americanus is reported to survive for 3-10 years [56] [57] but to be capable of living for up to 15 years, [58] and possibly even 18 years. [59] However, in a few hosts, it may die in as little as three months. (For more about this, see Hookworm lifespan.) TTthe human whipworm, Trichuris trichiura can survive for more than 2 years, and occasionally in excess of 5 years [60] but, in some hosts, may die in under a year. [61]

TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis and HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta are both adapted to non-human species, the natural host of the former being the pig, and the latter normally being found in rats. As the human gut is an alien environment for both these organisms, they only survive in humans for a short time, typically just a couple of weeks, during which time the molecules they excrete/secrete distract the host’s immune system.

The fact that TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis and HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta rarely mature in humans has led some commentators to speculate that these nonhuman helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] may not be as effective, therapeutically, as the human-adapted worms, NAthe human hookworm, Necator americanus and TTthe human whipworm, Trichuris trichiura, and it may be that helminth efficacy is enhanced in the case of mature, egg-producing worms. [62]

The view that human-adapted helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] such as NAthe human hookworm, Necator americanus and TTthe human whipworm, Trichuris trichiura might be more effective, therapeutically, than nonhuman worms like TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis and HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta, was discussed in detail in a support group thread. [63] This idea has also received support from William Parker, who has referred to human helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] as our true “old friends”, and TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis, HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta and other helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] that prefer non-human hosts as, at best, our "old semi-acquaintances".

People who have switched from using TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis to either NAthe human hookworm, Necator americanus or TTthe human whipworm, Trichuris trichiura have often done so because they are much cheaper. However, many who have made this transition have subsequently commented that they have found the therapeutic benefits of NAthe human hookworm, Necator americanus and TTOthe ova (eggs) of the human whipworm, Trichuris trichiura to be greater than those of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis.

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I previously tried TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis and it dampened the UCUlcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset. somewhat, but not to the extent that human whipwormsA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. (TTthe human whipworm, Trichuris trichiura) have. [64]
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I tried pig whipwormA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. way back but it had zero effect on me. It wasn’t until I got on human worms (both NAthe human hookworm, Necator americanus and TTthe human whipworm, Trichuris trichiura) that I saw the extreme positive effects that the worms give. [65]
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I have UCUlcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) which specifically affects the large intestine, or colon, causing characteristic ulcers, or open sores. The main symptom of active disease is constant diarrhea mixed with blood, of gradual onset. and tried TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis for 6 months with no results. But 10 NAthe human hookworm, Necator americanus works like a charm. [66]

Response time

All four helminth species have shown themselves to be capable of producing surprisingly rapid results in some cases, although benefits rarely become consistent with the human helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], NAthe human hookworm, Necator americanus and TTOthe ova (eggs) of the human whipworm, Trichuris trichiura, until at least 12 weeks after the first inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation].

Some self-treaters have reported that the non-human helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths], TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis and HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta, have produced benefits more rapidly than NAthe human hookworm, Necator americanus and TTOthe ova (eggs) of the human whipworm, Trichuris trichiura.

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TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis relieves my symptoms the quickest of all helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths]. [67]
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They (TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis) started working after the second dose. [68]
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I started with 2,500 TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis every two weeks and saw improvement in 11 days. It took me about 16 1/2 months to get to that same level of improvement with the human worms. [69]
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HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta is very fast acting for me... By the 3rd or 4th day my burning sore lungs are no longer sore. [70]

While evidence from clinical trials is still lacking, feedback reported by one researcher and a commercial supplier of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta suggests that a significant proportion of people using this species seem to respond in days or weeks rather than months, and this provider advises clients that, if they have not experienced any benefit in 12-16 weeks, it is unlikely they will see a positive response.

However, HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta and TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis have not always delivered benefits so quickly.

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TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis took 4½ months to kick in for me...
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... about this assumption that HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta works faster. It definitely doesn't for me.” [71]

And there are reports of NAthe human hookworm, Necator americanus delivering rapid benefits in some cases.

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It's been exactly a week since my first inoculationThe introduction of an infectious agent into an organism. [http://helminthictherapywiki.org/wiki/index.php/Helminth_inoculation Helminth inoculation] of 25 HWhookworm, usually referring to the human hookworm, Necator americanus... my asthma got much better at day 2. Also my allergies seem to have gotten a little better... I feel great right now actually. Its awesome to be able to breathe in a 100%! [72]
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On the second day after my new gut buddies (NAthe human hookworm, Necator americanus) moved in, their ministrations brought significant relief from the nasal congestion that I had had, on and off, for most of my life.” [73]

Shelf life

HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta. After extraction from beetles, HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta will not remain viable for more than 48 hours if kept in saline, but will survive for 2 to 3 weeks if stored in the special nutrient solution developed for this species by Biome Restoration. Unless such a solution is used, HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta deteriorate rapidly after extraction. Fresh HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta should therefore be used within 24 hours of being harvested - not 24 hours after receipt. For more detail, see Storage and survival of HDC.

NAthe human hookworm, Necator americanus. NAthe human hookworm, Necator americanus larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. can survive for as long as 3-5 months if kept at a favourable temperature (70ºF/21ºC) but should be used as soon as they are available. L3 larvaeThe active immature form of an insect, or an animal such as a helminth, which develops from an egg and eventually transforms again into its adult state. do not feed, so are reliant on their fat stores, which obviously diminish over time, rendering them progressively weaker. For more detail, see Storage and survival of hookworm larvae.

TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis / TTOthe ova (eggs) of the human whipworm, Trichuris trichiura. WhipwormA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. ova (both TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis and TTOthe ova (eggs) of the human whipworm, Trichuris trichiura) can remain viable for a couple of years if stored in a refrigerator, so keeping a supply of these in reserve can be a useful insurance for users of NAthe human hookworm, Necator americanus against the loss of their colony, or an interruption in its benefits following the use of antibiotics. Since TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis usually produces results more rapidly than TTOthe ova (eggs) of the human whipworm, Trichuris trichiura, this is the ideal species to keep for such an emergency.

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I keep TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis for emergencies, such as, if I have to take antibiotics, or I accidentally ingest something that harms my (human) helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths]. [74]

Dosing frequency

The non-human helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] (TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis and HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta) need to be re-dosed every 2 or 3 weeks in most cases. A disadvantage of the need for such regular re-dosing is that self-treaters can forget to take doses, and a few HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta users have reported experiencing a return of symptoms as a result of deviating from the usual fortnightly dosing regimen. These include the mother of a child with Crohn’s disease who reported that her son began to bleed on two occasions as a result of delays in taking his doses of HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta. Others have reported suffering a sudden return of symptoms due to delays in taking HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta.

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Missed a dose, no fault of anyone, life just got in the way... Been w/o for a month. Horrific dysautonomia, which is constant dizziness, neck pain... [75]
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I did once miss a dose for 30 days, and there was hell to pay on that account. My immune system went crazy for about a week, until I could get a new dose. [76]

It is also possible to forget to re-dose with NAthe human hookworm, Necator americanus and TTOthe ova (eggs) of the human whipworm, Trichuris trichiura but, since human worms don’t usually all die at the same time, the return of symptoms in their case is normally much more gradual, so users of NAthe human hookworm, Necator americanus and TTOthe ova (eggs) of the human whipworm, Trichuris trichiura can forget about dosing until they begin to see a gradual return of the symptoms of their disease, which typically only occurs every few years.

Hosting multiple worm species

It is clear, both from scientific studies and the personal experience of helminthic therapyThe reintroduction to the digestive tract of a controlled number of specially domesticated, mutualistic helminths (intestinal worms) in the form of microscopic eggs or larvae to reconstitute a depleted biome to treat and prevent chronic inflammation, autoimmune disease and other immunological disorders including allergy. self-treaters, that a single species of worm is all that is required in most cases to modulate host immunity and halt existing immune-related disorders, as well as protecting the host from the development of many other conditions associated with a helminth deficiency. And it has been shown that the beneficial effect of helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] is not specific to any single helminth species. [77] However, different species of helminth can produce somewhat different effects.

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I use 3 species of helminthsAn intestinal worm which grows large enough to be seen with the naked eye when mature but which is microscopic when administered in helminthic therapy. [https://en.wikipedia.org/wiki/Helminths Wikipedia:Helminths] and each one has particular characteristics and effects. [78]
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I reacted to HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta and HWhookworm, usually referring to the human hookworm, Necator americanus completely different... [79]
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I think NAthe human hookworm, Necator americanus helps tamp down inflammation overall and gives the TTOthe ova (eggs) of the human whipworm, Trichuris trichiura a chance to take hold. I think NAthe human hookworm, Necator americanus helps with stool formation while TTOthe ova (eggs) of the human whipworm, Trichuris trichiura heals colon ulcers, thus stopping blood and mucus loss, restoring gut wall. [80]

Exposure to multiple intestinal worms may promote even stronger immunological regulation [81] [82] and this has been confirmed by self-treaters.

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HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta and NAthe human hookworm, Necator americanus make a powerful combo for me that reduces symptoms even more than NAthe human hookworm, Necator americanus alone. [83]

One particular benefit provided by hosting a second species of worm is that this may help to reduce the increased attrition sometimes experienced in cases where subjects have a disease affecting the preferred location of the worm species they’re already using. For example, subjects with Crohn’s disease are susceptible to inflammation in the small intestine, which is where NAthe human hookworm, Necator americanus resides, with the result that this species can have more difficulty attaching in order to feed. Consequently, they tend not to survive in Crohn’s patients for as long as they might do in hosts with other diseases.

It may therefore be advantageous for Crohn’s sufferers to host a second species that lives elsewhere, such as TTthe human whipworm, Trichuris trichiura or TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis, both of which live in the colon. Similarly, subjects using TTthe human whipworm, Trichuris trichiura to treat colitis may have difficulty maintaining a whipwormA helminth with a tapering whiplike body that lives in the colon. In helminthic therapy, the microscopic eggs of either the human Trichuris trichiura (TTO) or pig Trichuris suis (TSO) are taken in a drink. colony due to colonic inflammation hampering attachment by these worms, in which case they might benefit from also hosting NAthe human hookworm, Necator americanus which contribute systemic inflammation control.

Another possible reason for users of NAthe human hookworm, Necator americanus and TTthe human whipworm, Trichuris trichiura to add a further species would be to ensure a more rapid response when first commencing therapy. Temporarily using either TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis or HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta at this point might speed remission, since these species produce rapid results more reliably.

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I do think starting with TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis is great because you get a therapeutic colony right away. Also, I think having the TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis on board minimizes side effects from the human worms.” [84]

However, starting more than one species at the same time can result in greatly increased side effects.

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I got crazy side effects when I started the HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta and NAthe human hookworm, Necator americanus close together. The worm fluThe term commonly used to describe the set of symptoms sometimes experienced initially after inoculation with helminths (especially the hookworm, NA). Some of these symptoms mirror those caused by [https://en.wikipedia.org/wiki/Influenza influenza] - fever, cough, respiratory symptoms, chills, muscle or joint ache, fatigue, abdominal pain, diarrhoea, nausea and vomiting. phase can be brutal if you start them about the same time. [85]

A self-treaterSomeone who treats their own disease or condition without medical supervision. with MCASMast cell activation syndrome, also referred to as mast cell activation disorder (MCAD). An immunological condition. [https://en.wikipedia.org/wiki/Mast_cell_activation_syndrome Wikipedia:Mast cell activation syndrome] who combined HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta with NAthe human hookworm, Necator americanus also found that this combination was too much for him and caused increased anxiety for 6-8 weeks, until he cancelled the HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta. [86]

TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis or HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta could be useful to hosts of NAthe human hookworm, Necator americanus if their colony were to sustain accidental losses, for example following the use of some types of antibiotic. TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis is ideal for this purpose since, unlike HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta, this organism remains viable for years if kept in a refrigerator. A supply of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis can therefore be kept in reserve by users of NAthe human hookworm, Necator americanus to provide assurance that they will never be without the benefits of worms.

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… what really helped her … was 2 doses of TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis that she had while waiting for the (hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.) colony to start working again. [87]
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Keeping TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis on hand to bridge the gap while rebuilding a (hookwormA helminth that lives in the small intestine. Necator americanus (NA) is the only hookworm species used in helminthic therapy. Its microscopic larvae are applied periodically to the skin.) colony works for me too. [88]

Keeping a different species of worm in reserve may not be necessary for users of TTthe human whipworm, Trichuris trichiura if they are dosing on a regular basis, in which case they will usually have a supply of TTOthe ova (eggs) of the human whipworm, Trichuris trichiura in their fridge that they can reach for if required.

If switching from one species to another, there may be a hiatus in benefits until the new species is able to fully take control of immune modulation, so it may be best to maintain the previous species until this point.

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I took HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta for a year. HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta worked really great. I felt very well... Changing from HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta to TSOthe ova (eggs) of the porcine (pig) whipworm, Trichuris suis was like starting from scratch. All my symptoms came back and took 4½ months to get back to where my best was while taking HDCthe cysticercoids (larval cysts) of the rat tapeworm, Hymenolepis diminuta. [89]
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