View source for Selecting a therapeutic helminth

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==Considerations when choosing a therapeutic helminth==

* [[Introduction to helminthic therapy#Therapeutic helminths | '''List of currently available therapeutic helminths''']]

There is no single "best" worm or worm combination for all conditions, but some worms do have a better track record with certain diseases.

<div style="background-color:#FFF5FA;border: 1px solid #F2CEDD; padding:8px; border-radius:5px; margin-bottom:12px;">The following details, based on anecdotal reports, offer a rough guide to which species might be best to try first in some of the most frequently encountered medical conditions. 

Species shown in '''bold type''' are generally more likely to help, but this can vary between individuals.
{{Columns|3}}
Alopecia areata - '''HDC''' / TSO<br>
Asthma - '''NA''' / '''HDC''' / TSO<br>
Autism - '''TSO''' / '''HDC''' (NA may help with some of the co-morbidities of autism.)<br>
Autoimmune diseases - '''NA''' / '''TSO''' / '''HDC'''<br>
Allergies, contact - '''TSO''' / NA / HDC<br>
Allergies, seasonal - '''NA''' / '''HDC''' / TSO<br>
Allergies, food - '''TSO''' / '''NA''' / HDC<br>
Colitis (ulcerative colitis, pancolitis, Crohn's colitis) - '''TSO''' / '''TTO''' / NA / HDC<br>
Crohn’s disease -  '''NA''' / '''TSO''' / HDC<br>
Fatigue - '''NA''' / TSO<br>
Food intolerance - '''NA''' / TSO / HDC<br>
Irritable Bowel Syndrome (IBS) - '''TSO''' / '''NA''' / '''HDC'''<br>
Lichenoid eruption, Lichen planus - '''TSO'''<br>
Lupus - '''TSO''' / '''NA'''<br>
Multiple sclerosis, relapsing-remitting (RRMS) - '''NA''' / TSO / HDC<br>
Multiple sclerosis, progressive (PPMS and SPMS) - '''NA''' / TSO / HDC<br>
Neuropsychiatric disorders (e.g., depression, anxiety, bipolar, etc.) - '''HDC''' / NA<br>
Rheumatoid arthritis - '''TSO''' / '''NA'''<br>
{{Columns}}
</div>
<div style="background-color:#CEDFF2; border:1px solid #A3B0BF; padding:8px; border-radius:5px; margin-bottom:12px;">Further insights to help with species selection can be found in the following two resources.
* [[Helminthic therapy personal stories | '''Helminthic therapy personal stories''']]
This page shows which worm species have been used by self-treaters reporting success with each of the listed conditions.
* [http://www.yourwildlife.org/wp-content/uploads/2015/05/galley-proof-v2.pdf Overcoming Evolutionary Mismatch by Self-Treatment with Helminths: Current Practices and Experience] (PDF)
Table 2 of this paper contains details about the effectiveness of each worm species in the treatment of the conditions listed, as reported by self-treaters who were surveyed in the study.<br>
Table 3 shows the percentage success rate of each worm species in the treatment of the listed conditions, based on information collected from publicly available sources. 
</div> 
Even with the benefit of the details presented above, personal experimentation may still be required in order to establish exactly which worm, or worm combination, will be best in the longterm for each self-treater.

{{Quote|indent}}There's just the simple thing of what you respond to best. It’s not good or bad about species, but just about you. [https://www.facebook.com/groups/htsupport/permalink/2019264371462841/?comment_id=2019862254736386&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

The further details presented below should provide additional help in selecting a worm to try first.

== The scientific evidence ==

There have been no head-to-head clinical trials comparing any of the currently available therapeutic 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 the individual helminths used in therapy, although almost all species of intestinal worm appear to be capable of producing beneficial effects.

{{Quote|indent}}Almost any worm species that has been tested, in almost any animal model of immunity, autoimmunity, or allergy, has given positive data. [https://www.healthline.com/health-news/why-people-subject-themselves-to-worm-therapy-treatments#1]{{Quote|/indent}}

In the groundbreaking Correale and Farez study of 2007 in patients with multiple sclerosis, [http://www.ncbi.nlm.nih.gov/pubmed/17230481] all the helminth-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 therapy.

The only organism to be studied in the treatment of autoimmune disease in well designed trials at therapeutic doses is TSO, and this has been shown to be safe and effective in ulcerative colitis, [http://www.gastrojournal.org/article/S0016-5085(05)00025-9/pdf] (PDF) promising in the management of Crohn's disease [http://www.ncbi.nlm.nih.gov/pubmed/15591509] as well as in the treatment of relapsing-remitting multiple sclerosis (RRMS) [http://www.ncbi.nlm.nih.gov/pubmed/21372112] and also in dampening allergic airway hyper-reactivity. [https://www.ncbi.nlm.nih.gov/pubmed/25069662] TSO has also shown significant results in 70% of subjects with the inflammatory subtype of autism spectrum disorder (I-ASD) who took TSO in its original pH2.7 form. [https://www.facebook.com/tanawisa/posts/746878402097165]

Several other trials of TSO 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 TSO 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. [https://www.facebook.com/tanawisa/posts/584426468342360], [https://www.facebook.com/groups/htsupport/permalink/796491757073448/]

The first trial of the hookworm, NA, 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), [https://www.clinicaltrials.gov/ct2/show/NCT01470521?term=Worms+for+Immune+Regulation+of+Multiple+Sclerosis&rank=1] 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, TTO and HDC, although there was a detailed case study of an individual with ulcerative colitis who experienced almost complete remission of his symptoms after self-infecting with TTO, [http://www.ncbi.nlm.nih.gov/pubmed/?term=21123809] and a further case study showing several indicators of mucosal and systemic immune modulation following self infection with TTO. [https://www.ncbi.nlm.nih.gov/pubmed/27743501] A study in mice showed that Infection with HDC was superior to daily corticosteroids in the prevention of colitis in this species, and that this did not result in any additional side effects. [https://www.ncbi.nlm.nih.gov/pubmed/20011066]

== The anecdotal evidence ==

While data from clinical trials is still limited, the anecdotal evidence gathered by the self-treaters who have pioneered helminthic therapy for more than a decade is already significant and compelling. See [[Helminthic therapy personal stories | '''Helminthic therapy personal stories''']] and the following paper.

* [http://www.yourwildlife.org/wp-content/uploads/2015/05/galley-proof-v2.pdf Overcoming Evolutionary Mismatch by Self-Treatment with Helminths: Current Practices and Experience] (PDF) 

Apart from this study, there is little recorded anecdotal evidence for TSO and HDC, largely because users of these two organisms, and especially TSO, have been much less active on helminthic therapy social media sites. In contrast, NA has been discussed extensively online since 2007, and, to a lesser extent, TTO, since 2009, originally on the  [https://groups.yahoo.com/neo/groups/helminthictherapy/info Yahoo Helminthic Therapy Forum] and, more recently, in the [https://www.facebook.com/groups/htsupport/ Facebook Helminthic Therapy Support Group].

=== NA (Necator americanus) ===

{{Quote|indent}}There is perhaps no better example of a therapeutic parasite than the hookworm, Necator americanus. [http://www.sciencedirect.com/science/article/pii/S0020751912003062]{{Quote|/indent}}
NA, which has the longest lifespan of the currently available therapeutic 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. [https://groups.yahoo.com/neo/groups/helminthictherapy/conversations/messages/2043] [https://groups.yahoo.com/neo/groups/helminthictherapy/conversations/messages/2852] [https://groups.yahoo.com/neo/groups/helminthictherapy/conversations/messages/3365] The extent of its benefits can be seen in the hundreds of reports in the compilation of <span class="pops">[[Helminthic_therapy_personal_stories | '''Helminthic therapy personal stories''']]</span>, most of which are from users of NA.

This organism causes a short-lived, but often itchy, rash at the inoculation site in most subjects, and may produce a very pleasant, if brief, [[The helminthic therapy bounce | '''“bounce”''']] in the first few weeks following inoculation, as well as causing other well documented transient side effects during the first few months. (See [[Hookworm timeline | '''The hookworm timeline''']]) However, it does not cause any long-term ill effects.

Concern is sometimes expressed about the safety of self-infection with NA, 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 NA hosts, and the “tissue damage” caused by hookworms needs to be seen in context. For more detail about all these issues, see [[Helminthic therapy safety#The safety of NA | '''The safety of NA''']].

For information about the use of NA, see the following pages.

* [[Self-treating with NA | '''Self-treating with NA''']]

* [[Hookworm dosing and response | '''Hookworm dosing and response''']]

* [[Hookworm timeline | '''Hookworm timeline''']]

* [[Hookworm side effects | '''Hookworm side effects''']]

=== TTO (Trichuris trichiura ova) ===

The colon-dwelling Trichuris trichiura, which has an effect that is less systemic than that of NA and more localised in the colon, is most frequently employed in the treatment of ulcerative colitis and colonic Crohn’s disease. Its effect on these disorders may be related to its ability to reduce the inflammatory Bacteroides species which are thought to be involved in the aetiology of inflammatory bowel disease. [https://www.ncbi.nlm.nih.gov/pubmed/27080105] Some people with these diseases seem to do well using TTO alone. 

{{Quote|indent}}I just got word after the last colonoscopy that my pan colitis is fully disappeared. After nearly a decade of failed treatments, I am fine thanks to a course of TTO. [https://www.facebook.com/groups/htsupport/permalink/2037920129597265/]{{Quote|/indent}}

Others have found it best to combine TTO with NA.

{{Quote|indent}}I successfully take hookworm and TTO to keep my UC in remission. I take 10 NA every four months and 50 TTO eggs every two weeks. [https://www.facebook.com/groups/htsupport/permalink/2009933872395891/?comment_id=2011275478928397&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

{{Quote|indent}}The TTO I think help my colonic issues the most and the NA help with some of the systemic/allergic issues I've had and my overall mood (they help me feel relaxed and often euphoric). [https://www.facebook.com/groups/htsupport/permalink/631572663565359/?comment_id=1419645544758063&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

{{Quote|indent}}We have noticed a bigger improvement since my daughter has got her hookworm levels to above 80, in combination with whipworms. I think they really help the inflammation. [https://www.facebook.com/groups/htsupport/permalink/813907268665230/?comment_id=813920028663954&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

Some people have had more success using NA alone.

{{Quote|indent}}I'm someone with UC, and NA keeps me in remission. For some people, TTO is way better, but I think the NA is doing the magic for me. [https://www.facebook.com/groups/htsupport/permalink/1565624633493486/?comment_id=1565754846813798&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

Others have found the greatest benefit from using NA supported by TTO.

{{Quote|indent}}I have Crohn's in my large intestine but for whatever reason NA seems to do most of the heavy lifting for treating my disease. However the TTO does help. [https://www.facebook.com/groups/htsupport/permalink/1532120320177251/?comment_id=1532199130169370&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

A ''few'' people have felt less well after adding NA on top of TTO, and a ''few'' others have reported being less well after adding TTO to an existing colony of NA. [https://www.facebook.com/groups/htsupport/permalink/555510421171584/]

Some people who have tried both TTO and TSO have found the human species to be more effective.

{{Quote|indent}}I previously tried TSO and it dampened the UC somewhat, but not to the extent that human whipworms (TT) have. TSO, however, never caused me any side effects. But the cost of TSO is insanely astronomical to anyone but a millionaire, and I suspect that colonization by the worms does indeed bring on a higher level of therapeutic value. [https://groups.yahoo.com/neo/groups/helminthictherapy/conversations/messages/3712]{{Quote|/indent}}

Although TT is used primarily in the treatment of diseases affecting the colon, and its systemic effect is less than that of NA, it does nevertheless produce immune modulation in areas beyond the intestine, [https://www.ncbi.nlm.nih.gov/pubmed/27743501] so may assist in the remediation of diseases elsewhere in the body, in a way similar to how its close relative, TS (Trichuris suis, which also lives in the colon) is able to reduce the number of brain lesions in MS patients. [https://www.ncbi.nlm.nih.gov/pubmed/21372112]

Since TT produces significant changes in the composition and relative abundance of gut bacterial species, [https://www.ncbi.nlm.nih.gov/pubmed/23166490] it is possible that it may also help to ameliorate any condition that is driven by intestinal dysbiosis, such as obesity, diabetes (type I and type II), cancer and neurological disorders. 

For information about the use of TTO, see the following page.

* [[Self-treating with TTO | '''Self-treating with TTO''']]

=== TSO (Trichuris suis ova) ===

TSO has a localised effect in the colon [http://www.ncbi.nlm.nih.gov/pubmed/15825065] similar to that of TTO, so is particularly effective in the treatment of diseases affecting this section of the intestine, such as ulcerative colitis. It has also proved to be effective against autoimmune disorders affecting other parts of the body, especially Lupus and Crohn’s disease [http://www.ncbi.nlm.nih.gov/pubmed/15591509] but may not be as effective against MS as NA. [https://www.facebook.com/groups/htsupport/permalink/806465786076045/?comment_id=806846026038021&offset=0&total_comments=14] TSO can also be effective in autism, [https://www.facebook.com/groups/htsupport/permalink/806465786076045/?comment_id=806846026038021&offset=0&total_comments=14][http://www.ncbi.nlm.nih.gov/pubmed/22742834][http://www.ncbi.nlm.nih.gov/pubmed/25054339] perhaps more so than any of the other worms, [https://www.facebook.com/groups/htsupport/permalink/964566830265939/?comment_id=964755193580436&comment_tracking=%7B%22tn%22:%22R%22%7D]
although the extent of its effect is dependent on the sub-type of autism exhibited, [https://www.facebook.com/groups/htsupport/permalink/1031021503620471/] and NA is reportedly helpful in addressing some of the medical co-morbidities that accompany autism. [https://www.facebook.com/groups/htsupport/permalink/806465786076045/?comment_id=806903232698967&comment_tracking=%7B%22tn%22%3A%22R%22%7D] TSO has been reported to
efficiently dampen allergic airway hyper-reactivity [http://www.ncbi.nlm.nih.gov/pubmed/25069662] and has been claimed to be very effective in the treatment of food and contact allergies, [https://www.facebook.com/groups/htsupport/permalink/862220600500563/?comment_id=864094833646473&offset=0&total_comments=10&comment_tracking=%7B%22tn%22:%22R%22%7D] although less effective than NA against seasonal allergies. 

As with other helminth species, TSO may cause transient side effects when first introduced, especially, but not limited to, minor gastrointestinal problems and mild spasms.

{{Quote|indent}}TSO caused me a few days of looser stools and a rumbling gut, then it settled down around the 4 to 5 day mark. [https://www.facebook.com/groups/htsupport/permalink/811167795605844/?comment_id=811233562265934&offset=0&total_comments=5&comment_tracking=%7B%22tn%22:%22R0%22%7D]{{Quote|/indent}}
{{Quote|indent}}So, tomorrow I take dose 2 of TSO... My chronic sinus/eustachian issues seem to be flaring. [https://www.facebook.com/groups/htsupport/permalink/1231041430285143/]{{Quote|/indent}}
In some people, temporary mild side effects may continue to be experienced following all doses in the long term. 
{{Quote|indent}}I feel fine after 3 days of gut upset. [https://www.facebook.com/groups/htsupport/permalink/917407071648582/?comment_id=922641651125124&comment_tracking=%7B%22tn%22:%22R2%22%7D]{{Quote|/indent}}
Approximately 80% of people who take at least one full course of TSO (10 doses, one of which is taken every 2 weeks) may achieve disease remission and, according to the producer of TSO, around 60% of these subjects will continue to experience remission for between 1 and 3 years. This was demonstrated by the experience of one TSO user.

{{Quote|indent}}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. [https://www.facebook.com/groups/htsupport/permalink/892682854121004/?comment_id=892929367429686&offset=0&total_comments=4&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
During this time, some users of TSO may not need any further doses at all, while others might need to take a periodic maintenance dose, for example 500 TSO every month, [https://www.facebook.com/groups/htsupport/permalink/2072512692804675/?comment_id=2072646122791332&comment_tracking=%7B%22tn%22%3A%22R%22%7D] or every 2 months. [https://www.facebook.com/groups/htsupport/permalink/1171508829571737/?comment_id=1232626603459959&comment_tracking=%7B%22tn%22%3A%22R%22%7D] 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 colitis has reported being in remission for 9 years after taking a single course of TSO during a clinical trial.

There are, however, some users of TSO who do not continue to experience benefit after completing a course of 10 doses.
{{Quote|indent}}I did not go into remission though with 10 doses of 2500 TSO. [https://www.facebook.com/groups/htsupport/permalink/1097103447012276/?comment_id=1099199900135964&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}

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

For information about the use of TSO, see the following page.

* [[Self-treating with TSO | '''Self-treating with TSO''']]

=== HDC (Hymenolepis diminuta cysticercoids) ===

While anecdotal evidence about this latest addition to the list of therapeutic organisms is still limited in comparison with that available for NA and TT, posts to the helminthic therapy groups indicate that the HDC experience follows a similar course to that seen with other helminths, beginning with the possibility of initial transient side effects and leading to eventual success in many cases.

As with the other therapeutic helminths, HDC can cause initial side effects, some of which have been found to be quite challenging by a few users.

{{Quote|indent}}HDC does not have less side effects for everyone, it caused me a huge amount of discomfort. [https://www.facebook.com/groups/htsupport/permalink/867814563274500/?comment_id=867902723265684&offset=0&total_comments=9&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}

And it has been reported that approximately 1% of paediatric patients may experience severe gastrointestinal pains with the use of HDC, although these symptoms are resolved by the administration of an anthelminthic drug. [http://www.ncbi.nlm.nih.gov/pubmed/27240605]

A number of successes have been reported by HDC users, e.g.,

{{Quote|indent}}… my hay fever has been much better on HDC. Barely noticed it this year. [https://www.facebook.com/groups/htsupport/permalink/887916647930958/?comment_id=888383201217636&offset=0&total_comments=8&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
as well as some failures, e.g.,

{{Quote|indent}}… I’m on HDC 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!{{Quote|/indent}}
There are reports from subjects who have previously used NA that the effects of HDC can be more gentle and subtle than those produced by hookworms. 

{{Quote|indent}}“HDC seemed gentler / more subtle all around than NA{{Quote|/indent}}
but others have obtained more relief after adding, or switching to, NA.

{{Quote|indent}}After I’d been taking HDC for a while and established that there is no extra benefit for me in hosting HDC as well as NA, I killed off the hookworms to see what the HDC could do on their own. Unfortunately, nasal congestion returned within 48 hours of terminating the NA, and this persisted to such an extent that, after 5 weeks, I was desperate to restock with hookworms. Within two days of taking a dose of 40 HW larvae, the congestion receded. In the weeks that followed, I experienced symptoms that are typical after inoculating with NA, indicating that the HDC, which I had continued to take, were not effectively modifying my immune response to the new NA.{{Quote|/indent}}
HDC users frequently report a welcome elevation in mood, especially in the first few days after inoculation.

{{Quote|indent}}I like how it (HDC) puts me in a good mood for a day or two when I first take it.{{Quote|/indent}}
However, HDC can also have an adverse effect on mood.

{{Quote|indent}}The response I had from the HDC was sweating, feeling sick but it was also especially agitation and
depression. [https://www.facebook.com/groups/htsupport/permalink/917407071648582/?comment_id=927347233987899&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}

As larger numbers have begun using HDCs, more reports of adverse side effects have emerged. These have revealed transient problems very similar to those seen with hookworms, 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 HDC 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. 

{{Quote|indent}}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. [https://www.facebook.com/groups/263818550462551/permalink/495111963999874/?comment_id=495442790633458&offset=0&total_comments=4&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}

More examples of users’ experience with HDC can be found in [[The HDC experience | 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 HDC and TSO. [https://www.facebook.com/WilliamParkerLab/photos/a.1000745896713827.1073741827.1000152793439804/1004315533023530/?type=3&theater]

For information about the use of HDC, see the following pages.

*  [[Self-treating with HDC | '''Self-treating with HDC''']]

* [[The HDC experience | '''The HDC experience''']]

== Comparing human helminths with non-human helminths ==

NA and TT 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 ongoing, 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 helminths depends to a large extent on the vigour of the host’s immune response. NA is reported to survive for 3-10 years [http://www.ncbi.nlm.nih.gov/pubmed/627275] [https://www.facebook.com/groups/htsupport/permalink/1445776015478349/] but to be capable of living for up to 15 years, [http://www.parasitesinhumans.org/hookworms.html] and possibly even 18 years. [http://www.ncbi.nlm.nih.gov/pubmed/3189697] However, in a few hosts, it may die in as little as three months. (For more about this, see [[Self-treating with NA#Hookworm lifespan | '''Hookworm lifespan''']].) TT can survive for more than 2 years, and occasionally in excess of 5 years. [https://www.facebook.com/groups/htsupport/permalink/1373519749370643/?comment_id=1373650899357528&comment_tracking=%7B%22tn%22%3A%22R0%22%7D] There has even been one report of TT showing up during colonoscopy 7 years after inoculation, but they are more likely to die in under a year. [https://www.facebook.com/groups/htsupport/permalink/1465757733480177/?comment_id=1465783760144241&reply_comment_id=1465959096793374&comment_tracking=%7B%22tn%22%3A%22R%22%7D]

TSO and HDC 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 TSO and HDC rarely mature in humans has led some commentators to speculate that these nonhuman helminths may not be as effective, therapeutically, as the human-adapted worms, NA and TT, and it may be that helminth efficacy is enhanced in the case of mature, egg-producing worms. [http://www.ncbi.nlm.nih.gov/pubmed/23967364]

The view that human-adapted helminths such as NA and TT might be more effective, therapeutically, than nonhuman worms like TSO and HDC, was discussed in detail in a support group thread. [https://www.facebook.com/groups/htsupport/342264095829552/] This idea has also received support from [https://surgery.duke.edu/faculty/william-parker-phd William Parker], who has referred to human helminths as our true “old friends”, and TSO, HDC and
other helminths that prefer non-human hosts as, at best, our "old semi-acquaintances".

People who have switched from using TSO to either NA or TT 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 NA and TTO to be greater than those of TSO.

{{Quote|indent}}I previously tried TSO and it dampened the UC somewhat, but not to the extent that human whipworms (TT) have. [https://groups.yahoo.com/neo/groups/helminthictherapy/conversations/messages/3712]{{Quote|/indent}}
{{Quote|indent}}I tried pig whipworm way back but it had zero effect on me. It wasn’t until I got on human worms (both NA and TT) that I saw the extreme positive effects that the worms give. [https://www.facebook.com/groups/htsupport/permalink/870003726388917/?comment_id=870076549714968&offset=0&total_comments=3&comment_tracking=%7B%22tn%22:%22R0%22%7D]{{Quote|/indent}}
{{Quote|indent}}I have UC and tried TSO for 6 months with no results. But 10 NA works like a charm. [https://www.facebook.com/groups/htsupport/permalink/1575934982462451/?comment_id=1577180649004551&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I tried to take other species when I lost my NA - I tried TSO and HDC, sadly they do not have the same effect for me. [https://www.facebook.com/groups/htsupport/permalink/1668313273224621/?comment_id=1668394316549850&reply_comment_id=1669089563146992&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

=== 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 helminths, NA and TTO, until at least 12 weeks after the first inoculation. 

Some self-treaters have reported that the non-human helminths, TSO and HDC, have produced benefits more rapidly than NA and TTO.

{{Quote|indent}}TSO relieves my symptoms the quickest of all helminths. [https://www.facebook.com/groups/htsupport/permalink/938964552826167/?comment_id=939307192791903&comment_tracking=%7B%22tn%22:%22R2%22%7D]{{Quote|/indent}}
{{Quote|indent}}They (TSO) started working after the second dose. [https://www.facebook.com/groups/htsupport/permalink/1005760636146558/?comment_id=1006206686101953&comment_tracking=%7B%22tn%22:%22R0%22%7D]{{Quote|/indent}}
{{Quote|indent}}I started with 2,500 TSO every two weeks and saw improvement in 11 days. It took me about 16½ months to get to that same level of improvement with the human worms. [https://www.facebook.com/groups/htsupport/permalink/1218356591553627/?comment_id=1219158224806797&comment_tracking=%7B%22tn%22%3A%22R2%22%7D]{{Quote|/indent}}
{{Quote|indent}}HDC is very fast acting for me... By the 3rd or 4th day my burning sore lungs are no longer sore. [https://www.facebook.com/groups/htsupport/permalink/911465048909451/?comment_id=934894396566516&reply_comment_id=934897063232916&comment_tracking=%7B%22tn%22:%22R9%22%7D]{{Quote|/indent}}
{{Quote|indent}}I was a very fast responder to HDC. It was amazing. I did not have the same reaction to NA. [https://www.facebook.com/groups/htsupport/permalink/1657413694314579/?comment_id=1657463527642929&comment_tracking=%7B%22tn%22%3A%22R3%22%7D]{{Quote|/indent}}
While evidence from clinical trials is still lacking, feedback reported by one researcher and a commercial supplier of HDC 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, HDC and TSO have not always delivered benefits so quickly. 

{{Quote|indent}}TSO took 4½ months to kick in for me...{{Quote|/indent}}
{{Quote|indent}}... about this assumption that HDC works faster. It definitely doesn't for me.” [https://www.facebook.com/groups/htsupport/permalink/911465048909451/?comment_id=911490252240264&offset=0&total_comments=12&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
And there are reports of NA delivering rapid benefits in some cases. 

{{Quote|indent}}It's been exactly a week since my first inoculation of 25 HW... 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%! [https://www.facebook.com/groups/htsupport/permalink/883562655033024/?comment_id=884424508280172&offset=0&total_comments=31&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}On the second day after my new gut buddies (NA) moved in, their ministrations brought significant relief from the nasal congestion that I had had, on and off, for most of my life.” [http://www.foodsmatter.com/allergy_intolerance/food_intolerance/articles/worms_for_food_intolerance.html]{{Quote|/indent}}

=== Shelf life ===

'''HDC'''. After extraction from beetles, HDC 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, HDC deteriorate rapidly after extraction. Fresh HDC should therefore be used within 24 hours of being harvested - not 24 hours after receipt. For more detail, see [[Self-treating with HDC#Storage and survival of HDC | '''Storage and survival of HDC''']].

'''NA'''. NA larvae can survive for as long as 3-5 months if kept at a temperature of 60-65°F (15-18°C), [https://www.facebook.com/groups/678894952216125/permalink/1306907306081550/?comment_id=1307057629399851&comment_tracking=%7B%22tn%22%3A%22R1%22%7D] [https://www.facebook.com/groups/678894952216125/permalink/1437215226384090/] but, ideally, should be used as soon as they are available. L3 larvae do not feed, so are reliant on their fat stores, which obviously diminish over time, rendering them progressively weaker. For more detail, see [[Self-treating with NA#Storage and survival of hookworm larvae | '''Storage and survival of hookworm larvae''']].

'''TSO''' / '''TTO'''. Whipworm ova (both TSO and TTO) 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 NA against the loss of their colony, or an interruption in its benefits following the use of antibiotics. Since TSO usually produces results more rapidly than TTO, this is the ideal species to keep for such an emergency. 

{{Quote|indent}}I keep TSO for emergencies, such as, if I have to take antibiotics, or I accidentally ingest something that harms my (human) helminths. [https://www.facebook.com/groups/htsupport/permalink/793033264085964/?comment_id=807794845943139&offset=0&total_comments=10]{{Quote|/indent}}

=== Dosing frequency ===

The non-human helminths (TSO and HDC) 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 HDC 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 HDC. Others have reported suffering a sudden return of symptoms due to delays in taking HDC.

{{Quote|indent}}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... [https://www.facebook.com/groups/263818550462551/permalink/476237199220684/]{{Quote|/indent}}
{{Quote|indent}}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. [https://www.facebook.com/groups/263818550462551/permalink/495111963999874/?comment_id=495442790633458&offset=0&total_comments=4&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
It is also possible to forget to re-dose with NA and TTO 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 NA and TTO 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 therapy 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 helminths is not specific to any single helminth species. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825963/] However, different species of helminth can produce somewhat different effects.

{{Quote|indent}}I reacted to HDC and HW completely different... [https://www.facebook.com/groups/htsupport/permalink/1024089580980330/?comment_id=1024352220954066&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
{{Quote|indent}}I think NA helps tamp down inflammation overall and gives the TTO a chance to take hold. I think NA helps with stool formation while TTO heals colon ulcers, thus stopping blood and mucus loss, restoring gut wall. [https://www.facebook.com/groups/htsupport/permalink/1632453993477216/]{{Quote|/indent}}

It is possible that hosting one species of helminth might reduce a host's susceptibility to infection by other parasites, [https://www.ncbi.nlm.nih.gov/pubmed/30401814] although no difficulty has been reported by self-treaters in becoming infected by a second, or third, species of therapeutic helminth.

===Combining two species===

Exposure to two worm species at the same time may promote even stronger immunological regulation [http://jid.oxfordjournals.org/content/197/8/1204.full.pdf] [https://www.ncbi.nlm.nih.gov/pubmed/22035877] and this has been confirmed by self-treaters.

{{Quote|indent}}HDC and NA make a powerful combo for me that reduces symptoms even more than NA alone. [https://www.facebook.com/groups/htsupport/permalink/1582543915134891/?comment_id=1582861648436451&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

Combining two species can provide a greater range of benefits.

{{Quote|indent}}I use both NA and HDC and find that they affect me in different ways. NA affects my hormones (period symptoms change), dental health (less inflammation), and skin (less keratosis pilaris). The HDC affects my mental health, which is the main thing I was hoping to address. [https://www.facebook.com/groups/htsupport/permalink/2319906524731956/?comment_id=2338315196224422&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

One particular benefit provided by hosting a second species of therapeutic helminth 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 NA 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 TT or TSO, both of which live in the colon. Similarly, subjects using TT to treat colitis may have difficulty maintaining a whipworm colony due to colonic inflammation hampering attachment by these worms, in which case they might benefit from also hosting NA which contribute systemic inflammation control.

Another possible reason for users of NA and TT to consider the use of a different species would be to ensure a more rapid response when first beginning therapy. Commencing with either TSO or HDC might speed remission, since these species can produce rapid results more reliably.

{{Quote|indent}}I do think starting with TSO is great because you get a therapeutic colony right away. Also, I think having the TSO on board minimizes side effects from the human worms.” [https://www.facebook.com/groups/htsupport/permalink/897464293642860/?comment_id=897492276973395&offset=0&total_comments=3&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}

However, introducing two species together when first beginning helminthic therapy can result in greatly increased side effects.
* [[Helminth inoculation#The first inoculation should be with a single species | '''The first inoculation should be with a single species''']]

One individual had little luck combining HDC with NA.

{{Quote|indent}}I tried HDC in addition to NA several times and didn't have much success; in fact, I believe it twice triggered flares… I have had very positive experiences with NA alone. [https://www.facebook.com/groups/htsupport/permalink/1878874945501785/?comment_id=1878957405493539&comment_tracking=%7B%22tn%22%3A%22R%22%7D]{{Quote|/indent}}

TSO or HDC could be useful to hosts of NA if their colony were to sustain accidental losses, for example following the use of some types of antibiotic. TSO is ideal for this purpose since, unlike HDC, this organism remains viable for years if kept in a refrigerator. A supply of TSO can therefore be kept in reserve by users of NA to provide assurance that they will never be without the benefits of worms. 

{{Quote|indent}}… what really helped her … was 2 doses of TSO that she had while waiting for the (hookworm) colony to start working again. [https://www.facebook.com/groups/htsupport/permalink/1005760636146558/]{{Quote|/indent}}
{{Quote|indent}}Keeping TSO on hand to bridge the gap while rebuilding a (hookworm) colony works for me too. [https://www.facebook.com/groups/htsupport/permalink/1005760636146558/?comment_id=1005936292795659&comment_tracking=%7B%22tn%22:%22R%22%7D]{{Quote|/indent}}
Keeping a different species of worm in reserve may not be necessary for users of TT if they are dosing on a regular basis, in which case they will usually have a supply of TTO 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.

{{Quote|indent}}I took HDC for a year. HDC worked really great. I felt very well... Changing from HDC to TSO was like starting from scratch. All my symptoms came back and took 4½ months to get back to where my best was while taking HDC. [https://www.facebook.com/groups/htsupport/permalink/1038136062909015/]{{Quote|/indent}}

===Combining three or more species===

Adding a third therapeutic helminth has worked well for one self-treater.

{{Quote|indent}}I use 3 species of helminths and each one has particular characteristics and effects. [https://www.facebook.com/groups/htsupport/permalink/1112784965444124/?comment_id=1119411344781486&comment_tracking=%7B%22tn%22:%22R0%22%7D]{{Quote|/indent}}

There has been very little research into the results of hosting more than two species of helminth at one time, but, according to one study, the outcome of interactions between two parasite species can be significantly modified by the addition of a third, and the consequences of this may not always be desirable. In this study, investigators were looking at the effects of co-infection by four gastrointestinal helminth species on the development of cerebral malaria among Plasmodium falciparum-infected patients, and they found that the addition of a third species led to a reduction in one of the benefits provided by an existing species. 

The study found that, while infection by Trichuris trichiura and the non-therapeutic helminth, Ascaris lumbricoides, were both associated with direct reductions in cerebral malaria risk, the benefit of T. trichiura infection was halved in the presence of hookworms, revealing a strong indirect effect. [https://www.ncbi.nlm.nih.gov/pubmed/29746467]

== Obtaining helminths ==

Newcomers to helminthic therapy will often ask in the [https://www.facebook.com/groups/htsupport/ support group] for personal recommendations about the best place to buy helminths, but purchasing worms for therapy needs to be approached on an individual basis. 

None of the helminth providers sell all the available species, ship to all global destinations, or accept all payment options. And, while most sell individual doses, with discounts for purchasing multiple doses at one time, a few offer longer term contracts. Therefore, the details for each provider need to be carefully scrutinised before making a decision about which source to use. 

* [[Helminth providers | '''Helminth providers''']] 
* [[Helminth provider reviews | '''Helminth provider customer reviews''']]