Difference between revisions of "Hookworm dosing and response"

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(→‎Overdosing on hookworms: Rearranged and amended text to stress the possible reappearance of side effects as well as the loss of benefits.)
(→‎Long-term dosing in practice: Removed an example.)
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Others have had to wait until beyond 12 months and, in a few cases, for as long as 18-24 months.  
Others have had to wait until beyond 12 months and, in a few cases, for as long as 18-24 months.  
{{Quote|indent}}I got improvement in about 3 months but my eczema wasn't gone until I'd had NA for a couple years or so. [https://www.facebook.com/groups/htsupport/permalink/3576993069023289/?comment_id=3577189242337005&reply_comment_id=3577828172273112]{{Quote|/indent}}


{{Quote|indent}}At 16½ months, I think my hookworms and whipworms are really starting to work! Since (two weeks ago), I have had only 3 loose stools… I have more periods of relief than periods of exacerbation from my nasal inflammation and asthma. [https://www.facebook.com/groups/htsupport/permalink/1211935162195770/]{{Quote|/indent}}
{{Quote|indent}}At 16½ months, I think my hookworms and whipworms are really starting to work! Since (two weeks ago), I have had only 3 loose stools… I have more periods of relief than periods of exacerbation from my nasal inflammation and asthma. [https://www.facebook.com/groups/htsupport/permalink/1211935162195770/]{{Quote|/indent}}
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The long wait can be a challenge, but the eventual rewards can make it worth while.
The long wait can be a challenge, but the eventual rewards can make it worth while.
{{Quote|indent}}It definitely takes a while! I'm in month 14 and I had my fair share of doubt and periods that felt quite bad. But things have been incredibly stable and calm for long periods of time and I can now safely say that I'm seeing amazing benefits. [https://www.facebook.com/groups/htsupport/permalink/2726061500783121?comment_id=3922843074438285]{{Quote|/indent}}


{{Quote|indent}}My daughter was under a year when we started and it took 10 months to see consistent results. In between that there were improvements on and off. Though it felt like forever at the time, the 10 months really isn’t much time for the amazing quality of her life now. 2½ years later, she improves more and more. [https://www.facebook.com/groups/htsupport/permalink/2305032642886011/?comment_id=2305581779497764&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}My daughter was under a year when we started and it took 10 months to see consistent results. In between that there were improvements on and off. Though it felt like forever at the time, the 10 months really isn’t much time for the amazing quality of her life now. 2½ years later, she improves more and more. [https://www.facebook.com/groups/htsupport/permalink/2305032642886011/?comment_id=2305581779497764&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
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{{Quote|indent}}I'm still figuring out the number of worms best for me, 5 years into this. For some of us, it's much more complicated than ‘take worms, get better'.{{Quote|/indent}}
{{Quote|indent}}I'm still figuring out the number of worms best for me, 5 years into this. For some of us, it's much more complicated than ‘take worms, get better'.{{Quote|/indent}}
<div style="background-color:#FFF5FA; border:1px solid #F2CEDD; padding:8px; padding-left:8px; margin-bottom:12px;">
== '''Hookworm dosing in a nutshell''' ==


<div style="background-color:#F5FAFF; border: 1px solid #CEDFF2; padding:8px; padding-left:8px; margin-bottom:26px;margin-top:26px;">
<div style="border:1px solid #A3B0BF;background-color:#CEDFF2;padding-left:8px;"><h2 style = "margin-top:10px;border:0px solid #CEDFF2;">Hookworm dosing in a nutshell</h2></div>
1. Start with 5 NA larvae. (For children, see [[Hookworm dosing and response#Hookworm dosing in children | '''Hookworm dosing in children''']] below.)
1. Start with 5 NA larvae. (For children, see [[Hookworm dosing and response#Hookworm dosing in children | '''Hookworm dosing in children''']] below.)
:If the self-treater is hypersensitive or has one of [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''several specific conditions''']], they should start with just 3 larvae.  
:If the self-treater is hypersensitive or has one of [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''several specific conditions''']], they should start with just 3 larvae.  
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2. Add supplementary doses at intervals of at least 12 weeks.  
2. Add supplementary doses at intervals of at least 12 weeks.  


:The number of larvae in each successive dose can be increased ''gradually'', while being careful to avoid overdosing, which can cause side effects.
:The number of larvae in each successive dose can be increased '''''gradually''''', while being careful to avoid overdosing, which can cause side effects.


:There is no need to aim for any particular colony size. All that is necessary is to regularly add fresh doses to ensure that there are always young adult worms present in the gut.
:There is no need to aim for any particular colony size. All that is necessary is to regularly add fresh doses to ensure that there are always young adult worms present in the gut.
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The individuals behind the first online hookworm vendor separated early in their association to form two companies - Autoimmune Therapies (AIT) and Worm Therapy - which recommended different doses for those commencing hookworm therapy. In the case of AIT, a first dose of 35 larvae was followed by two doses of 50 larvae at 12 week intervals. Worm Therapy started their new clients with a dose of 25 larvae, and based the size and timing of subsequent doses on the recipient’s response to their first dose.
The individuals behind the first online hookworm vendor separated early in their association to form two companies - Autoimmune Therapies (AIT) and Worm Therapy - which recommended different doses for those commencing hookworm therapy. In the case of AIT, a first dose of 35 larvae was followed by two doses of 50 larvae at 12 week intervals. Worm Therapy started their new clients with a dose of 25 larvae, and based the size and timing of subsequent doses on the recipient’s response to their first dose.


Numerous early hookworm self-treaters who used these two regimens reported significant side effects from the doses they were supplied, especially clients of AIT. One self-treater had to contend with 19 weeks of intermittent diarrhoea from weeks 5 to 24 following an initial dose of 35 larvae, and someone who used AIT’s full 35/50/50 sequence was hospitalised with organ damage, which was fortunately reversed by medical treatment. [https://www.ncbi.nlm.nih.gov/pubmed/29623983]  
Numerous early hookworm self-treaters who used these two regimens reported significant side effects from the doses they were supplied, especially clients of AIT. One self-treater had to contend with 19 weeks of intermittent diarrhoea from weeks 5 to 24 following an initial dose of 35 larvae, and someone who used AIT’s full 35/50/50 sequence was hospitalised with organ damage that required medical treatment. [https://helminthictherapywiki.org/wiki/images/8/85/Symptomatic_hypereosinophilia_associated_with_Necator_americanus_self-inoculation.pdf]  


For the first few years after hookworms became available commercially, the only online discussion about helminthic therapy was in a [https://groups.yahoo.com/neo/groups/helminthictherapy/info Yahoo forum] created and run by AIT, where this company’s approach to dosing was accepted, largely without question.  
For the first few years after hookworms became available commercially, the only online discussion about helminthic therapy was in a Yahoo forum created and run by AIT, where this company’s approach to dosing was accepted, largely without question.  


'''The online community refined dosing based on collective experience'''
'''The online community refined dosing based on collective experience'''
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As more reports began to emerge of adverse side effects following the dosing protocols that were still in use, particularly by AIT, warnings were issued to Support group members about the risks of inoculating with too many hookworms, especially for those who have one of the conditions that are now listed as [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''requiring a modified approach to helminth dosing''']].
As more reports began to emerge of adverse side effects following the dosing protocols that were still in use, particularly by AIT, warnings were issued to Support group members about the risks of inoculating with too many hookworms, especially for those who have one of the conditions that are now listed as [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''requiring a modified approach to helminth dosing''']].


When this Helminthic Therapy Wiki was founded, in January 2017, this Hookworm Dosing and Response page became the repository for all the details about hookworm dosing that had been collected from posts to the Support group and elsewhere. This material showed very clearly that the previous approach to hookworm dosing had been flawed, and that not only are much smaller introductory doses preferable from the point of view of causing less side effects, but that they also produce the same level of efficacy as larger introductory doses, and provide a solid foundation for longterm dosing which might, for some self-treaters, eventually include much larger supplementary doses.
When this Helminthic Therapy Wiki was founded, in January 2017, this Hookworm Dosing and Response page became the repository for all the details about hookworm dosing that had been collected from posts to the Support group and elsewhere. This material showed very clearly that the previous approach to hookworm dosing had been flawed, and that not only are much smaller introductory doses preferable from the point of view minimising side effects, but that they can often  produce the same level of efficacy as larger introductory doses, and provide a solid foundation for longterm dosing which might, for some self-treaters, eventually include much larger supplementary doses.


'''New providers embraced the new approach to dosing'''  
'''New providers embraced the new approach to dosing'''  
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In 2014, a new breed of hookworm provider began to emerge, beginning with Wormswell (2014-2018), and followed by Symmbio (2016), YourSymbionts (2018) and Au NAturel (2019). These companies not only introduced a more user-friendly, pay-per-dose business model, but also worked more closely with the online community of helminth self-treaters than previous companies had done.  
In 2014, a new breed of hookworm provider began to emerge, beginning with Wormswell (2014-2018), and followed by Symmbio (2016), YourSymbionts (2018) and Au NAturel (2019). These companies not only introduced a more user-friendly, pay-per-dose business model, but also worked more closely with the online community of helminth self-treaters than previous companies had done.  


Once this wiki was available, the newer providers all recognised the site as the definitive database of information about all aspects of helminthic therapy, and contributed to the site's development. As the knowledge about hookworm dosing evolved, these three companies adopted an increasingly more conservative approach in line with the evidence presented on this page.  
Once this wiki was available, the newer providers all recognised the site as the definitive database of information about all aspects of helminthic therapy, and contributed to the site's development. As the knowledge about hookworm dosing evolved, these companies adopted an increasingly more conservative approach in line with the evidence presented on this page.  


AIT continued to apply their introductory 35/50/50 dosing protocol until 2017, except in the case of clients with fibromyalgia, who they had come to realise require much lower doses. But, after the company’s attention was drawn to this page, they adopted a new dosing regimen and, by late 2017, were introducing newcomers to the therapy with a dose sequence of 5/5/10/10/20/20 larvae. Worm Therapy, meanwhile, continued to start most of their new clients on a dose of 25 larvae, and persisted with this practice into at least the early part of 2019, even after their attention had been drawn to the data on this page, which they rejected as being merely anecdotal.
AIT continued to apply their introductory 35/50/50 dosing protocol until 2017, except in the case of clients with fibromyalgia, whom they had come to realise require much lower doses. After the company’s attention was drawn to this page, they adopted a new dosing regimen and, by late 2017, had begun to introduce newcomers to the therapy with a dose sequence of 5/5/10/10/20/20 larvae. Worm Therapy, meanwhile, continued to start most of their new clients on a dose of 25 larvae, and persisted with this practice into at least the early part of 2019, even after their attention had been drawn to the data on this page, which they rejected as being "merely anecdotal". The Llamas Clinic, which was closely associated with Worm Therapy between 2008 and 2018, is also believed to be reluctant to supply doses of less than 25 larvae.
 
Reports received by this wiki in 2020 and 2021 revealed that AIT had by that time reverted to recommending, and routinely supplying, doses of up to 50 NA larvae, even though dosing at this level had previously put at least one of their clients in hospital with potentially fatal side effects. [https://helminthictherapywiki.org/wiki/images/8/85/Symptomatic_hypereosinophilia_associated_with_Necator_americanus_self-inoculation.pdf] AIT have apparently even suggested that some of their clients should take supplementary doses of up to 100 larvae if they have failed to achieve the results they had hoped for. Usually, in this situation, most providers of NA will recommend the addition of a different species - typically either TSO or HDC - rather than the use of an excessive number of hookworms, but AIT only sells NA, and appear to rely on this species alone rather than suggesting the use of any other.


'''Obsolete dosing practice is perpetuated outside the online community'''  
'''Obsolete dosing practice is perpetuated outside the online community'''  


Medical practitioners with an interest in helminthic therapy who follow the conversation in the Helminthic Therapy Support group had mostly modified their approach to hookworm dosing by the start of 2019, and the majority were starting new patients on a dose of 5 larvae. A few, however, who are operating in isolation from the online community, and not keeping up to date via this wiki, continued to use larger doses, typically introducing new patients to the therapy with between one and three doses of 25 larvae. One naturopathic doctor was, in late 2018, still starting most of his patients on an initial dose of 25-35 larvae, followed by 2 or 3 doses of 20 larvae at three month intervals and then 5-10 larvae at 2 month intervals, a schedule that is diametrically opposed to what is suggested by user experience, as reported on this page.  
Medical practitioners with an interest in helminthic therapy who follow the conversation in the Helminthic Therapy Support group had mostly modified their approach to hookworm dosing by the start of 2019, and the majority were starting new patients on a dose of 5 larvae. A few, however, continued to operate in isolation from the online community, and were not keeping up to date via this wiki. Consequently unaware of the reports of severe side effects experienced by some self-treaters, these doctors continued to use a variety of idiosyncratic dosing protocols that often involved excessively large doses, for example, introducing new patients to the therapy with between one and three doses of 25 larvae.


There are some self-treaters who are not working with a doctor and who fail to find, or decide to overlook, the advice available on this page, and turn instead to obsolete information found on assorted sites across the internet, which leads them to seek larger hookworm doses than are advisable. Unfortunately, these individuals sometimes also turn a deaf ear to attempts by providers to encourage them to be more conservative in their dosing choices.  
In late 2018, one naturopathic doctor was still starting most of his patients on an initial dose of 25-35 larvae, followed by 2 or 3 doses of 20 larvae at three month intervals and then 5-10 larvae at 2 month intervals, a schedule that is diametrically opposed to what is suggested by user experience, as reported on this page.
 
In late 2020, another naturopathic doctor who was obviously aware of the need to start with much smaller doses, was nevertheless introducing too many doses in the first 12 weeks. Starting her patients with a single larva, she was adding a second one a week later, then following these with a further 5 larvae every two weeks until a colony of 20 was reached in the tenth week.
 
There are some self-treaters who are not working with a doctor and who fail to find, or decide to overlook, the advice available on this page, and turn instead to obsolete information found on assorted sites across the internet, which leads them to seek larger hookworm doses than are advisable. Unfortunately, these individuals sometimes even turn a deaf ear to attempts by providers to encourage them to be more conservative in their dosing choices.  


'''Hookworm dosing in research centres'''
'''Hookworm dosing in research centres'''
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The hookworm self-treaters who are members of the online community far outnumber the subjects who have taken part in the few formal clinical trials that have been mounted to investigate the therapeutic potential of hookworms, and the researchers involved in these studies have consequently had access to far less data to inform their understanding of the effects of different dose sizes.  
The hookworm self-treaters who are members of the online community far outnumber the subjects who have taken part in the few formal clinical trials that have been mounted to investigate the therapeutic potential of hookworms, and the researchers involved in these studies have consequently had access to far less data to inform their understanding of the effects of different dose sizes.  


Prior to 2006, researchers at Nottingham University had carried out a small dose-ranging study to identify a suitable dose size for their trials of therapeutic infection with NA in humans. [https://www.ncbi.nlm.nih.gov/pubmed/17123987] They concluded from this study that a dose of 10 NA larvae is well tolerated, elicits a modest eosinophilic and antibody response, and was potentially suitable for use in preliminary clinical therapeutic trials. However, after trials using single doses of 10 NA, the team at Nottingham then employed a single dose of 25 NA in their Worms in Relapsing Remitting Multiple Sclerosis (WiRMS) trial that ran from 2011 to 2016. [https://www.clinicaltrials.gov/ct2/show/NCT01470521] Other centres investigating the therapeutic effects of hookworms have used doses ranging from 10 to 40 larvae. [https://www.clinicaltrials.gov/ct2/show/NCT00671138] [https://www.clinicaltrials.gov/ct2/show/NCT01661933] [https://www.clinicaltrials.gov/ct2/show/NCT02754609]
Prior to 2006, researchers at Nottingham University had carried out a small dose-ranging study to identify a suitable dose size for their trials of therapeutic infection with NA in humans. [https://www.ncbi.nlm.nih.gov/pubmed/17123987] They concluded from this study that a dose of 10 NA larvae is well tolerated, elicits a modest eosinophilic and antibody response, and was potentially suitable for use in preliminary clinical therapeutic trials. However, after trials using single doses of 10 NA, the team at Nottingham then employed a single dose of 25 NA in their Worms in Relapsing Remitting Multiple Sclerosis (WiRMS) trial that ran from 2011 to 2016. [https://pubmed.ncbi.nlm.nih.gov/32539079/] Other centres investigating the therapeutic effects of hookworms have used doses ranging from 10 to 40 larvae. [https://www.clinicaltrials.gov/ct2/show/NCT00671138] [https://www.clinicaltrials.gov/ct2/show/NCT01661933] [https://www.clinicaltrials.gov/ct2/show/NCT02754609]


The information on this page, condensed from the experience of thousands of citizen scientists in the online community, could have been invaluable to medical researchers, had they chosen to utilise it. For example, they would have discovered the importance of maintaining a hookworm colony by continuing to add supplementary doses at appropriate intervals, but, unfortunately, medical research has largely ignored the experience of helminth self-treaters and the data presented here.
The information on this page, condensed from the experience of thousands of citizen scientists in the online community, could be invaluable to medical researchers, if they chose to utilise it. For example, they would come to appreciate the need for implementation of a dose-finding scheme to establish the ideal dose for each trial subject, and they would discover the importance of maintaining a hookworm colony by continuing to add supplementary doses at appropriate intervals. Unfortunately, however, medical research has largely ignored the experience of helminth self-treaters and the data presented here.
 
'''Socio-medical research confirms established best dosing practice'''
 
Socio-medical research published in 2020 [https://helminthictherapywiki.org/wiki/images/9/94/Socio-medical_studies_of_individuals_self-treating_with_helminths_suggest_that_most_clinical_trials_assessing_helminth_therapy_may_be_designed_to_fail.pdf] confirmed what had been learned by self-treaters over the previous 8 years, viz., that there is such wide variation between individuals in their ability to tolerate helminths, as well as in their therapeutic response to them, that the use of individualised dosing is essential. By 2020, this was already appreciated by the majority of helminth suppliers and those physicians who provide information to self-treaters, and the use of an initial dose-finding approach was being widely recommended and practised in preference to attempting therapy with a standard dose applied to all individuals.
 
As is explained in detail on the rest of this page, the dose-finding approach used initially in hookworm-naive individuals entails starting with a dose of 3-5 NA larvae and then gradually working up to higher doses until either symptoms are relieved or adverse side effects indicate a need to reduce dosage. Failure to start with low exposure levels of NA was described by one of the physicians interviewed by the researchers as being irresponsible and fraught with problems.
If future clinical trials are to effectively test the potential of helminth therapy, they must address the challenge of implementing dose-finding schemes in their subject cohorts. And, if self-treaters are to be guided towards reaping the greatest benefits from this therapy without incurring undue side effects, all helminth providers and advising physicians must also adopt the dose-finding approach.


== The first dose ==
== The first dose ==
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Individuals who are hypersensitive, or have at least one of [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''these conditions''']], are advised to commence with just 3 NA.
Individuals who are hypersensitive, or have at least one of [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''these conditions''']], are advised to commence with just 3 NA.


===Those who began with dose of 50 or more NA have usually regretted it!===
===Those who began with a dose of 50 or more NA have usually regretted it!===


Early pioneers who inoculated with 50 larvae eventually wished they hadn’t! Prof David Pritchard of Nottingham University School of Pharmacy could not cope with a single inoculation of 50 hookworm larvae, [http://www.dailymail.co.uk/health/article-434226/Madman-hero-The-medical-maverick-let-50-hookworms-burrow-arm.html] and Dr James Logan from the London School of Hygiene and Tropical Medicine, who inoculated with 50 hookworm larvae for a UK TV documentary, had to abort the experiment after 60 days, saying, "I just can't live with the symptoms and the stomach pains.” [https://www.theguardian.com/technology/2013/dec/01/extreme-science-hookworms-james-logan]
Early pioneers who inoculated with 50 larvae eventually wished they hadn’t! Prof David Pritchard of Nottingham University School of Pharmacy could not cope with a single inoculation of 50 hookworm larvae, [http://www.dailymail.co.uk/health/article-434226/Madman-hero-The-medical-maverick-let-50-hookworms-burrow-arm.html] and Dr James Logan from the London School of Hygiene and Tropical Medicine, who inoculated with 50 hookworm larvae for a UK TV documentary, had to abort the experiment after 60 days, saying, "I just can't live with the symptoms and the stomach pains.” [https://www.theguardian.com/technology/2013/dec/01/extreme-science-hookworms-james-logan]
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{{Quote|indent}}I had huge side effects from my first dose of 5 NA. I had to take a few days off at the worst moment... [https://www.facebook.com/groups/htsupport/permalink/1121353877920566/?comment_id=1121581877897766&comment_tracking=%7B%22tn%22:%22R0%22%7D]{{Quote|/indent}}
{{Quote|indent}}I had huge side effects from my first dose of 5 NA. I had to take a few days off at the worst moment... [https://www.facebook.com/groups/htsupport/permalink/1121353877920566/?comment_id=1121581877897766&comment_tracking=%7B%22tn%22:%22R0%22%7D]{{Quote|/indent}}
{{Quote|indent}}After 3 weeks of 5 NA I had an intense reaction. My depression flared, got really sick, had a huge rash break out on my face, lost my appetite and developed hypersomnia. [https://www.facebook.com/groups/htsupport/permalink/3478972928825304/?comment_id=3488684371187493&reply_comment_id=3488858387836758]{{Quote|/indent}}
{{Quote|indent}}I inoculated about 4 weeks ago with 5 NA. The last ten days have been rough. I've been experiencing cold/flu symptoms for the past ten days that started to clear up and then came back with a vengeance, plus some other symptoms more in line with a flare. Fatigue, deep and persistent coughing, insomnia, post nasal drip, congestion, constant acid reflux, random itching all over my body/skin sensitivity, swelling, worsening of my existing skin problems, trouble regulating my body temperature, neuropathy in hands, and food cravings. I also had a migraine last week for the first time since I started treating my autoimmune disease with plaquenil. I'm going to a clinic tomorrow to ask for prednisone. (Link expired){{Quote|/indent}}


{{Quote|indent}}I also took 5 NA and started getting HORRIBLE stomach pains at Day 28. Like my insides were shredding. I am at Day 41 now, still having intense pain, but taking Benadryl (antihistamine in US) has helped a lot... [https://www.facebook.com/groups/htsupport/permalink/1381206295268655/?comment_id=1381812371874714&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I also took 5 NA and started getting HORRIBLE stomach pains at Day 28. Like my insides were shredding. I am at Day 41 now, still having intense pain, but taking Benadryl (antihistamine in US) has helped a lot... [https://www.facebook.com/groups/htsupport/permalink/1381206295268655/?comment_id=1381812371874714&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}


{{Quote|indent}}I am about 14 weeks post innoculating with 5 NA. I had quite a lot of difficult symptoms from weeks 3-10 post innoculation:, stomach pain, bloating, feeling feverish & really tired. I got through it just, but since I was ill anyway, holding down a job with all that was hard. [https://www.facebook.com/groups/htsupport/permalink/1765694283486519/]{{Quote|/indent}}
{{Quote|indent}}Horrible fatigue today… (at 2 days). [https://www.facebook.com/groups/htsupport/permalink/2092455257477085/] Too much fatigue, can't stand any more. This is simply unbearable… I should have taken just 3... (at 4.5 weeks). [https://www.facebook.com/groups/htsupport/permalink/2135581166497827/?comment_id=2135584446497499&reply_comment_id=2135609303161680&comment_tracking=%7B%22tn%22%3A%22R%22%7D] [https://www.facebook.com/groups/htsupport/permalink/2135581166497827/?comment_id=2135691013153509&reply_comment_id=2135695096486434&comment_tracking=%7B%22tn%22%3A%22R%22%7D] (Reported by a patient with CFS/ME, after inoculating with 5 NA.){{Quote|/indent}}
 
{{Quote|indent}}I inoculated about 4 weeks ago with 5 NA. The last ten days have been rough. I've been experiencing cold/flu symptoms for the past ten days that started to clear up and then came back with a vengeance, plus some other symptoms more in line with a flare. Fatigue, deep and persistent coughing, insomnia, post nasal drip, congestion, constant acid reflux, random itching all over my body/skin sensitivity, swelling, worsening of my existing skin problems, trouble regulating my body temperature, neuropathy in hands, and food cravings. I also had a migraine last week for the first time since I started treating my autoimmune disease with plaquenil. I'm going to a clinic tomorrow to ask for prednisone. (Link expired){{Quote|/indent}}


{{Quote|indent}}Since week five (with 5 NA) I've had some pretty rough side effects. Constant fatigue, brain fog, and some depression... I can't eat much of anything right now. [https://www.facebook.com/groups/htsupport/permalink/1412378752151409/?comment_id=1448660711856546&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}Since week five (with 5 NA) I've had some pretty rough side effects. Constant fatigue, brain fog, and some depression... I can't eat much of anything right now. [https://www.facebook.com/groups/htsupport/permalink/1412378752151409/?comment_id=1448660711856546&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
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{{Quote|indent}}This is Day 61 (with 5 NA). Having a hard time with the stomach pains, nausea, and now very strong muscle pains. All of my muscles are so tight. Feels like EVERY single muscle. [https://www.facebook.com/groups/htsupport/permalink/1335248503197768/?comment_id=1388003157922302&comment_tracking=%7B%22tn%22%3A%22R9%22%7D]{{Quote|/indent}}
{{Quote|indent}}This is Day 61 (with 5 NA). Having a hard time with the stomach pains, nausea, and now very strong muscle pains. All of my muscles are so tight. Feels like EVERY single muscle. [https://www.facebook.com/groups/htsupport/permalink/1335248503197768/?comment_id=1388003157922302&comment_tracking=%7B%22tn%22%3A%22R9%22%7D]{{Quote|/indent}}


{{Quote|indent}}Horrible fatigue today… (at 2 days). [https://www.facebook.com/groups/htsupport/permalink/2092455257477085/] Too much fatigue, can't stand any more. This is simply unbearable… I should have taken just 3... (at 4.5 weeks). [https://www.facebook.com/groups/htsupport/permalink/2135581166497827/?comment_id=2135584446497499&reply_comment_id=2135609303161680&comment_tracking=%7B%22tn%22%3A%22R%22%7D] [https://www.facebook.com/groups/htsupport/permalink/2135581166497827/?comment_id=2135691013153509&reply_comment_id=2135695096486434&comment_tracking=%7B%22tn%22%3A%22R%22%7D] (Reported by a patient with CFS/ME, after inoculating with 5 NA.){{Quote|/indent}}
{{Quote|indent}}I am about 14 weeks post innoculating with 5 NA. I had quite a lot of difficult symptoms from weeks 3-10 post innoculation:, stomach pain, bloating, feeling feverish & really tired. I got through it just, but since I was ill anyway, holding down a job with all that was hard. [https://www.facebook.com/groups/htsupport/permalink/1765694283486519/]{{Quote|/indent}}


{{Quote|indent}}After my first dose of 5HW I experienced extreme fatigue. It wasn't until my third dose that things began to make a big shift. [https://www.facebook.com/groups/htsupport/permalink/856163037772986/?comment_id=856646297724660&offset=0&total_comments=5&comment_tracking=%7B%22tn%22:%22R0%22%7D]{{Quote|/indent}}
{{Quote|indent}}After my first dose of 5HW I experienced extreme fatigue. It wasn't until my third dose that things began to make a big shift. [https://www.facebook.com/groups/htsupport/permalink/856163037772986/?comment_id=856646297724660&offset=0&total_comments=5&comment_tracking=%7B%22tn%22:%22R0%22%7D]{{Quote|/indent}}
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{{Quote|indent}}Whenever I add more NA, my asthma comes back... not as bad as before I started NA. But then after 8 weeks, the asthma goes away entirely. [https://www.facebook.com/groups/htsupport/permalink/1526717137384236/?comment_id=1529107580478525&comment_tracking=%7B%22tn%22%3A%22R%22%7D] [https://www.facebook.com/groups/htsupport/permalink/1526717137384236/?comment_id=1529174360471847&reply_comment_id=1529193553803261&comment_tracking=%7B%22tn%22%3A%22R1%22%7D]{{Quote|/indent}}
{{Quote|indent}}Whenever I add more NA, my asthma comes back... not as bad as before I started NA. But then after 8 weeks, the asthma goes away entirely. [https://www.facebook.com/groups/htsupport/permalink/1526717137384236/?comment_id=1529107580478525&comment_tracking=%7B%22tn%22%3A%22R%22%7D] [https://www.facebook.com/groups/htsupport/permalink/1526717137384236/?comment_id=1529174360471847&reply_comment_id=1529193553803261&comment_tracking=%7B%22tn%22%3A%22R1%22%7D]{{Quote|/indent}}


Once supplementary doses are no longer causing side effects or exacerbating the disease being treated, the size of doses can be ''gradually'' and cautiously increased, while remaining vigilant for any return of adverse effects.  
Once supplementary doses are no longer causing side effects or exacerbating the disease being treated, the size of doses can be '''''gradually'' and ''cautiously''''' increased, while remaining vigilant for any return of adverse effects.  


===A ''few'' NA hosts may eventually tolerate doses of between 35 and 50 larvae===
===A ''few'' NA hosts may eventually tolerate doses of between 35 and 50 larvae===
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=== Larger doses may potentially cause organ damage in rare cases ===
=== Larger doses may potentially cause organ damage in rare cases ===


There has been a single report in the scientific literature of a case of reversible damage to the heart myocardium (in addition to Loeffler’s syndrome affecting the lungs) as a result of hypereosinophilia following inoculation over 7 months with three large doses of NA. (35/50/50) [https://www.ncbi.nlm.nih.gov/pubmed/29623983]
There has been a single report in the scientific literature of a case of reversible damage to the heart myocardium (in addition to Loeffler’s syndrome affecting the lungs) as a result of hypereosinophilia following inoculation over 7 months with three large doses (35/50/50) of NA. [https://helminthictherapywiki.org/wiki/images/8/85/Symptomatic_hypereosinophilia_associated_with_Necator_americanus_self-inoculation.pdf]


=== Supplementary doses may be best kept under 20 or 25 ===
=== Supplementary doses may be best kept under 20 or 25 ===
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===Some people need to restrict supplementary doses to 5 larvae or less===
===Some people need to restrict supplementary doses to 5 larvae or less===


Some self-treaters have found that they need to continue to use very small doses, and that these provide them with all the benefits they require. This is particularly true for those on the hypersensitivity spectrum, who should continue to inoculate with very low numbers for at least the first few doses, and possibly indefinitely.
Some self-treaters have found that they need to continue to use very small doses, and that these provide them with all the benefits they require. This is particularly true for those on the hypersensitivity spectrum, who should continue to inoculate with very low numbers for at least the first few doses, and possibly indefinitely. It is also true for a small number of self-treaters who are helminth permissive. These individuals have a reduced ability to control helminths, probably due to their genetic profile, so they accumulate worms rather than losing them to the relentless attrition that limits worm numbers in most people.  


{{Quote|indent}}I did 5 and did well for 5 months then did 10 and caused massive CFS/ME flare. [https://www.facebook.com/groups/htsupport/permalink/1286104968112122/?comment_id=1286147761441176&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I did 5 and did well for 5 months then did 10 and caused massive CFS/ME flare. [https://www.facebook.com/groups/htsupport/permalink/1286104968112122/?comment_id=1286147761441176&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
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===A few people may need to pause treatment after just one or two doses===
===A few people may need to pause treatment after just one or two doses===


Not everyone needs to add supplementary doses routinely every 12 weeks, and doing this can prove counter-productive for some hypersensitive individuals.
Not everyone needs to add supplementary doses routinely every 12 weeks, and doing this can prove counter-productive for some hypersensitive, or helminth-permissive, individuals.


{{Quote|indent}}I did three NA and did relatively ok. After three months, I did three more, but this second dose made my symptoms about 10 times worse. I was sicker then ever before, with even more symptoms that I’d never had previously. So I terminated. (Via private message.){{Quote|/indent}}
{{Quote|indent}}I did three NA and did relatively ok. After three months, I did three more, but this second dose made my symptoms about 10 times worse. I was sicker then ever before, with even more symptoms that I’d never had previously. So I terminated. (Via private message.){{Quote|/indent}}
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===Long-term dosing is based on individual user experience===
===Long-term dosing is based on individual user experience===


'''Hookworm hosts should keep a record of the size and dates of all their doses while they are gradually introducing larvae within their individual tolerance. Once they have achieved remission, they should pause dosing and note the length of time that it takes between their last inoculation and the reappearance of symptoms of their disease. This will provide the best guide to the frequency with which they will need to re-inoculate in the long term in order to maintain uninterrupted remission.'''
The frequency with which NA hosts need to reinoculate varies widely between individuals.
 
{{Quote|indent}}It appears I lose my worms every three months. My relative went about five months before her symptoms returned. [https://www.facebook.com/groups/htsupport/permalink/1550216578367625/?comment_id=1550314855024464&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
 
The size of doses required also varies considerably between individual users.
 
'''In order for hookworm hosts to establish the ideal dose size and dosing frequency for them, they should keep a record of the size and dates of all their doses while they are gradually introducing larvae within their individual tolerance. Once they have achieved remission, they should pause dosing and note the length of time that it takes between their last inoculation and the reappearance of symptoms of their disease. This will provide the best guide to the frequency with which they will need to re-inoculate in the long term in order to maintain uninterrupted remission.'''


{{Quote|indent}}I can tell when the NA die off and I need to take another dose because my gluten sensitivity flares up, my headaches are worse and my aches and pains are worse. [https://www.facebook.com/groups/htsupport/permalink/2490868600969080/?comment_id=2491288504260423]{{Quote|/indent}}
{{Quote|indent}}I can tell when the NA die off and I need to take another dose because my gluten sensitivity flares up, my headaches are worse and my aches and pains are worse. [https://www.facebook.com/groups/htsupport/permalink/2490868600969080/?comment_id=2491288504260423]{{Quote|/indent}}
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The following comments illustrate the range of dose sizes and dosing frequency being used, and show that many self-treaters top up at least every 3-6 months.
The following comments illustrate the range of dose sizes and dosing frequency being used, and show that many self-treaters top up at least every 3-6 months.
<blockquote>
<blockquote>
{{Quote|indent}}I do best at 2-3 month redoses. If I wait longer, I wish I hadn't. [https://www.facebook.com/groups/htsupport/permalink/1550216578367625/?comment_id=1550226671699949&comment_tracking=%7B%22tn%22%3A%22R2%22%7D]{{Quote|/indent}}
'''12 months'''
{{Quote|indent}}... my body kills off hookworm every 3 months or so...” [https://www.facebook.com/groups/htsupport/permalink/821187211270569/?comment_id=821394977916459&offset=0&total_comments=13&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}Unless I take something that kills them, I probably only need 3 or so, once a year. [https://www.facebook.com/groups/htsupport/permalink/3077027792353155/?comment_id=3077049905684277&reply_comment_id=3077177339004867]{{Quote|/indent}}
{{Quote|indent}}I find 1-3 ok. Five is ok if (my colony is) low. But more than that I have symptoms... I will probably do 2 every 3 months as a topup. [https://www.facebook.com/groups/htsupport/permalink/1783444368378177/?comment_id=1783972631658684&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
'''5-6 months'''
{{Quote|indent}}I now take about 7-10 hookworms every 3-4 months. [https://www.facebook.com/groups/htsupport/permalink/1868023383253608/]{{Quote|/indent}}
{{Quote|indent}}I inoculate with 15 each 5 months, because I swear my baseline symptoms start to return at about 6 months post-inoculation. [https://www.facebook.com/groups/htsupport/permalink/1990194231036522/?comment_id=1990736610982284&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I inoculate with 15 each 5 months, because I swear my baseline symptoms start to return at about 6 months post-inoculation. [https://www.facebook.com/groups/htsupport/permalink/1990194231036522/?comment_id=1990736610982284&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I need to re-dose every 20 weeks. If I wait longer, symptoms return and I go through worm flu again (though diminished). If I re-dose every 20 weeks, results are more consistent. [https://www.facebook.com/groups/htsupport/permalink/1784511358271478/?comment_id=1784929798229634&reply_comment_id=1785466151509332&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I need 25 every six months.{{Quote|/indent}}
{{Quote|indent}}I inoculate with 30 about every 6 months. [https://www.facebook.com/groups/htsupport/permalink/1019138634808758/?comment_id=1019147878141167&reply_comment_id=1019335101455778&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I need to take 50 every 6 months.{{Quote|/indent}}
'''3-4 months'''
{{Quote|indent}}I find 1-3 NA ok. Five is ok if (my colony is) low. But more than that I have symptoms... I will probably do 2 every 3 months as a topup. [https://www.facebook.com/groups/htsupport/permalink/1783444368378177/?comment_id=1783972631658684&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I dose 20 NA at about 3 month Intervals. [https://www.facebook.com/groups/htsupport/permalink/1355341874521764/?comment_id=1358034104252541&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I dose 20 NA at about 3 month Intervals. [https://www.facebook.com/groups/htsupport/permalink/1355341874521764/?comment_id=1358034104252541&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I need 25 every 3 months. [https://www.facebook.com/groups/htsupport/permalink/1422151061174178/?comment_id=1422180437837907&comment_tracking=%7B%22tn%22%3A%22R3%22%7D]{{Quote|/indent}}
{{Quote|indent}}I need 25 every 3 months. [https://www.facebook.com/groups/htsupport/permalink/1422151061174178/?comment_id=1422180437837907&comment_tracking=%7B%22tn%22%3A%22R3%22%7D]{{Quote|/indent}}
{{Quote|indent}}I have to redose every three months also. 35 is my magic number. [https://www.facebook.com/groups/htsupport/permalink/1422151061174178/?comment_id=1422278597828091&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I have to redose every three months also. 35 is my magic number. [https://www.facebook.com/groups/htsupport/permalink/1422151061174178/?comment_id=1422278597828091&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I take 40 NA every 3 months. [https://www.facebook.com/groups/htsupport/permalink/1422151061174178/?comment_id=1422155307840420&comment_tracking=%7B%22tn%22%3A%22R5%22%7D]{{Quote|/indent}}  
{{Quote|indent}}I take 40 NA every 3 months. [https://www.facebook.com/groups/htsupport/permalink/1422151061174178/?comment_id=1422155307840420&comment_tracking=%7B%22tn%22%3A%22R5%22%7D]{{Quote|/indent}}  
{{Quote|indent}}I now take about 7-10 hookworms every 3-4 months. [https://www.facebook.com/groups/htsupport/permalink/1868023383253608/]{{Quote|/indent}}
'''2-3 months'''
{{Quote|indent}}I tried 20 NA every 3 months - it gave me worm flu. Now i've gone to 10 NA every 2 months, and it seems to work better for me personally. [https://www.facebook.com/groups/htsupport/permalink/3345728918816373/?comment_id=3347513468637918]{{Quote|/indent}}
{{Quote|indent}}I need 40 NA every 8 weeks, for now. [https://www.facebook.com/groups/678894952216125/permalink/2547577475347854/]{{Quote|/indent}}
{{Quote|indent}}I do best at 2-3 month redoses. If I wait longer, I wish I hadn't. [https://www.facebook.com/groups/htsupport/permalink/1550216578367625/?comment_id=1550226671699949&comment_tracking=%7B%22tn%22%3A%22R2%22%7D]{{Quote|/indent}}
{{Quote|indent}}I now dose with 40 every 2.5 months. I need a frequent high dose to keep my Crohn's under control. [https://www.facebook.com/groups/htsupport/permalink/2129859643736646/?comment_id=2132698830119394&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I now dose with 40 every 2.5 months. I need a frequent high dose to keep my Crohn's under control. [https://www.facebook.com/groups/htsupport/permalink/2129859643736646/?comment_id=2132698830119394&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I need 40 NA every 8 weeks, for now. [https://www.facebook.com/groups/678894952216125/permalink/2547577475347854/]{{Quote|/indent}}
'''1-2 months'''
{{Quote|indent}}It appears I lose my worms every three months. My relative went about five months before her symptoms returned. [https://www.facebook.com/groups/htsupport/permalink/1550216578367625/?comment_id=1550314855024464&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}My brother is now doing 3 NA every 4 weeks and that seems to be good for him as at 10-12 weeks he has return of symptoms. [https://www.facebook.com/groups/htsupport/permalink/1818402868215660/?comment_id=2078031412252803&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I need to re-dose every 20 weeks. If I wait longer, symptoms return and I go through worm flu again (though diminished). If I re-dose every 20 weeks, results are more consistent. [https://www.facebook.com/groups/htsupport/permalink/1784511358271478/?comment_id=1784929798229634&reply_comment_id=1785466151509332&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I have to dose with 5 NA per month to stay healthy. I kill them off quicker than most people. [https://www.facebook.com/groups/htsupport/permalink/3810264849029442?comment_id=3810326995689894]{{Quote|/indent}}<!-- Lorrie Nies Shinol -->
{{Quote|indent}}I need 25 every six months.{{Quote|/indent}}
{{Quote|indent}}I do 5 NA every 7 weeks. If I do it more often, I feel sick and flared up. If I space it out more, my autoimmune symptoms return. I listen to my body and this is what it needs at this point. I journal my symptoms so I’m able to see the patterns. [https://www.facebook.com/groups/htsupport/permalink/3271274592928473?comment_id=3272967132759219]{{Quote|/indent}}
{{Quote|indent}}I inoculate with 30 about every 6 months. [https://www.facebook.com/groups/htsupport/permalink/1019138634808758/?comment_id=1019147878141167&reply_comment_id=1019335101455778&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
'''1-2 weeks'''
{{Quote|indent}}I need to take 50 every 6 months.{{Quote|/indent}}
{{Quote|indent}}Unless I take something that kills them, I probably only need 3 or so, once a year. [https://www.facebook.com/groups/htsupport/permalink/3077027792353155/?comment_id=3077049905684277&reply_comment_id=3077177339004867]{{Quote|/indent}}
</blockquote>
A few hookworm hosts have found that they do best when they re-dose even more frequently, with commensurately smaller doses.
<blockquote>
{{Quote|indent}}My brother is now doing 3na every 4 weeks and that seems to be good for him as at 10-12weeks he has return of symptoms. [https://www.facebook.com/groups/htsupport/permalink/1818402868215660/?comment_id=2078031412252803&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
</blockquote>


Several people who have begun to increase the frequency of doses, while reducing the number of larvae in each dose, have continued this process until they were dosing every one or two weeks.
Several people who began to increase the frequency of doses, while reducing the number of larvae in each dose, have continued this process until they were dosing every one or two weeks.
<blockquote>
Someone who is treating ankylosing spondylitis went first from dosing quarterly to adding 10-15 NA every other month. [https://www.facebook.com/groups/htsupport/permalink/1150956801626940/?comment_id=1152010544854899&comment_tracking=%7B%22tn%22:%22R1%22%7D] Then, finally, he changed to adding 6 NA every two weeks. [https://www.facebook.com/groups/htsupport/permalink/2033965626659382/?comment_id=2034247119964566&reply_comment_id=2034346819954596&comment_tracking=%7B%22tn%22%3A%22R%22%7D]
The following self-treater went first from inoculating with 30 NA every 6 months to 5 every month.


{{Quote|indent}}I've recently experimented with 5 every month. I've found that this new schedule is much better at keeping my sinuses clear. I'm beginning to think that the number of larva is much less important than the frequency of inoculation. [https://www.facebook.com/groups/htsupport/permalink/1258218517567434/]{{Quote|/indent}}
{{Quote|indent}}I've found that this new schedule is much better at keeping my sinuses clear. I'm beginning to think that the number of larva is much less important than the frequency of inoculation. [https://www.facebook.com/groups/htsupport/permalink/1258218517567434/]{{Quote|/indent}}  


Then, after noting the improvements gained from more frequent dosing, he adopted a fortnightly regimen.  
After noting the improvements gained from more frequent dosing, he adopted a fortnightly regimen.  


{{Quote|indent}}I've recently started 2-3 hookworm every 2 weeks and am getting much better results than I did with 30 every 6 months. [https://www.facebook.com/groups/htsupport/permalink/1355341874521764/?comment_id=1357764114279540&comment_tracking=%7B%22tn%22%3A%22R%22%7D] [https://www.facebook.com/groups/htsupport/permalink/1422151061174178/?comment_id=1423257967730154&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I've recently started 2-3 hookworm every 2 weeks and am getting much better results than I did with 30 every 6 months. [https://www.facebook.com/groups/htsupport/permalink/1355341874521764/?comment_id=1357764114279540&comment_tracking=%7B%22tn%22%3A%22R%22%7D] [https://www.facebook.com/groups/htsupport/permalink/1422151061174178/?comment_id=1423257967730154&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
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And he has since changed to weekly dosing with just one larva.
And he has since changed to weekly dosing with just one larva.


Someone who is treating ankylosing spondylitis went first from quarterly dosing to every other month.
{{Quote|indent}} I need to inoculate every other month with 10-15 HW… [https://www.facebook.com/groups/htsupport/permalink/1150956801626940/?comment_id=1152010544854899&comment_tracking=%7B%22tn%22:%22R1%22%7D]{{Quote|/indent}}
And then, finally, to fortnightly.
{{Quote|indent}}I’m inoculating with 6 hookworm every two weeks. [https://www.facebook.com/groups/htsupport/permalink/2033965626659382/?comment_id=2034247119964566&reply_comment_id=2034346819954596&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
</blockquote>
'''The additional exposure to migrating larvae facilitated by more frequent inoculations may provide increased immune stimulation.'''   
'''The additional exposure to migrating larvae facilitated by more frequent inoculations may provide increased immune stimulation.'''   


{{Quote|indent}}… the larval phase of infection rather than the persisting egg-laying adult worms may be largely responsible for the cytokine production and so responders may be the more frequently/more recently exposed individuals. [https://www.ncbi.nlm.nih.gov/pubmed/16232230]{{Quote|/indent}}
{{Quote|indent}}… the larval phase of infection rather than the persisting egg-laying adult worms may be largely responsible for the cytokine production and so responders may be the more frequently/more recently exposed individuals. [https://www.ncbi.nlm.nih.gov/pubmed/16232230]{{Quote|/indent}}
</blockquote>


=== Trickle dosing, and sensitisation to NA ===
=== Trickle dosing, and sensitisation to NA ===
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{{Quote|indent}}My wife lost her colony due to an 8 days treatment of antibiotics. As we were in a hurry to replenish her colony, and so inoculating 20 every 20 days, she became sensitized to them. [https://www.facebook.com/groups/htsupport/permalink/795036227219001/?comment_id=796617140394243&offset=0&total_comments=17]{{Quote|/indent}}
{{Quote|indent}}My wife lost her colony due to an 8 days treatment of antibiotics. As we were in a hurry to replenish her colony, and so inoculating 20 every 20 days, she became sensitized to them. [https://www.facebook.com/groups/htsupport/permalink/795036227219001/?comment_id=796617140394243&offset=0&total_comments=17]{{Quote|/indent}}


The individual whose experience is described in this last quote has also found that inoculating with 8-10 NA larvae every 6-8 weeks also results in sensitisation to the worms, and foods begin to cause the symptoms that she experienced prior to first using NA, and which she associates with allergy: brain fog, blurry vision, tiredness, grumpyness and lack of motivation. If she is tested at that point with a vial of NA larvae, using Applied Kinesiology [https://www.foodsmatter.com/natural_medicine_comp_therapies/kinesiology/articles/applied_kinesiology.html], her muscles will invariably be found to be weak, suggesting that she has become allergic to the hookworms. Treatment using NAET [https://www.foodsmatter.com/natural_medicine_comp_therapies/naet/articles/naet_micky_rose.html] [https://www.foodsmatter.com/natural_medicine_comp_therapies/naet/articles/alberto_rivas.html] will usually restore normal muscle function, but, if retesting 24 hours later finds that her muscles are still weak, a second NAET treatment will be undertaken, and this invariably restores the benefits she usually enjoys as a result of hosting hookworms.  
The individual whose experience is described in this last quote has also found that inoculating with 8-10 NA larvae every 6-8 weeks also results in sensitisation to the worms, and foods begin to cause the symptoms that she experienced prior to first using NA, and which she associates with allergy: brain fog, blurry vision, tiredness, grumpyness and lack of motivation. If she is tested at that point with a vial of NA larvae, using Applied Kinesiology [https://www.foodsmatter.com/natural_medicine_comp_therapies/kinesiology/articles/applied_kinesiology.html], her muscles will invariably be found to be weak, suggesting that she has become allergic to the hookworms. Treatment using NAET [https://www.foodsmatter.com/natural_medicine_comp_therapies/naet/articles/naet_micky_rose.html] [https://www.foodsmatter.com/natural_medicine_comp_therapies/naet/articles/alberto_rivas.html][https://www.naet.com/about/what-is-naet/] will usually restore normal muscle function, but, if retesting 24 hours later finds that her muscles are still weak, a second NAET treatment will be undertaken, and this invariably restores the benefits she usually enjoys as a result of hosting hookworms.  


The risk of sensitisation to hookworms is likely to be highest in hypersensitive subjects and those with allergies, and this is one reason why it is important to start hookworm therapy with no more than 5 larvae (just 3 for the hypersensitive and those with [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''certain other conditions''']]), and then to increase the size of supplementary doses very gradually so that any side effects that do develop will appear at a manageable rate rather than become suddenly so severe that termination is needed, or NAET treatment is required by those with access to this modality.
The risk of sensitisation to hookworms is likely to be highest in hypersensitive subjects and those with allergies, and this is one reason why it is important to start hookworm therapy with no more than 5 larvae (just 3 for the hypersensitive and those with [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''certain other conditions''']]), and then to increase the size of supplementary doses very gradually so that any side effects that do develop will appear at a manageable rate rather than become suddenly so severe that termination is needed, or NAET treatment is required by those with access to this modality.
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* [http://www.ncbi.nlm.nih.gov/pubmed/16890593 Allergy controls the population density of Necator americanus in the small intestine]  
* [http://www.ncbi.nlm.nih.gov/pubmed/16890593 Allergy controls the population density of Necator americanus in the small intestine]  


This assertion by Croese, et al., appears to be contradicted by the findings of more recent studies in which hookworm colonies observed in patients were described as "massive".
This assertion by Croese, et al., appears to be contradicted by the findings of a more recent study in which a colony of NA observed in a patient was described as "massive".


* [https://www.ncbi.nlm.nih.gov/pubmed/25926209 Obscure overt gastrointestinal bleeding due to Necator americanus diagnosed by double-balloon enteroscopy]  
* [https://www.ncbi.nlm.nih.gov/pubmed/25926209 Obscure overt gastrointestinal bleeding due to Necator americanus diagnosed by double-balloon enteroscopy]
 
* [https://www.ncbi.nlm.nih.gov/pubmed/26971967 Small bowel obstruction secondary to massive hookworm infestation complicated by fatal plurimicrobial bacteriemia]


There may also be different degrees of predisposition to hookworm infection in different groups, e.g., young/old, male/female, [https://www.ncbi.nlm.nih.gov/pubmed/29382360] and other influences on colony size may include blood group. [https://www.ncbi.nlm.nih.gov/pubmed/23286203]
There may also be different degrees of predisposition to hookworm infection in different groups, e.g., young/old, male/female, [https://www.ncbi.nlm.nih.gov/pubmed/29382360] and other influences on colony size may include blood group. [https://www.ncbi.nlm.nih.gov/pubmed/23286203]
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Children are usually introduced to hookworms with a first dose of 3, or possibly 5, larvae, but no more than 3 if they have one of the [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''conditions that require a modified approach to helminth dosing''']].
Children are usually introduced to hookworms with a first dose of 3, or possibly 5, larvae, but no more than 3 if they have one of the [[Helminthic therapy safety#Conditions that require a modified approach to helminth dosing | '''conditions that require a modified approach to helminth dosing''']].
{{Quote|indent}}My son was born with severe allergies to cows milk protein (bleeding rectally at 4 months) and developed really horrible eczema. First dose I gave him was 3 HW and it got rid of his eczema. Second dose was at age 4, 3rd at age 5. At age 5, I gave him 5 worms, if i recall correctly, and dosed 2x a year. Up until the age of 5 he was given no more than 3hw at a time once a year and it worked. As he grew older, he needed more. [https://www.facebook.com/groups/htsupport/permalink/3764345383621389/?comment_id=3765533550169239]{{Quote|/indent}}


Based on the child’s experience with the first dose, subsequent doses can be increased gradually, if required, using the approach described above in the [[Hookworm dosing and response#Supplementary doses | '''Supplementary doses''']] section.
Based on the child’s experience with the first dose, subsequent doses can be increased gradually, if required, using the approach described above in the [[Hookworm dosing and response#Supplementary doses | '''Supplementary doses''']] section.

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