Self-treating with TSO

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Home>Using helminths>Self-treating with TSO

The porcine (pig) whipworm, Trichuris suis, is supplied in small bottles containing 15ml of an isotonic, phosphate buffered saline solution at pH 2.4. Suspended in this liquid are minute, barely visible eggs that are referred to as ova, hence the abbreviation, "TSO". Since this species is not adapted to living in humans, it dies approximately 14 days after ingestion, following which it is completely digested, leaving no eggs or worms to be passed in faeces. During its short time in the body, the immature worm hatches from its egg and begins to grow, shedding molecules that modulate the host’s immune system and provide a legitimate target for it to attack. This prevents the immune system from responding inappropriately to innocent targets such as foods and pollens and the host’s own tissues, as happens in autoimmune diseases such as lupus, ulcerative colitis and Crohn’s disease.

Dosing with TSO[edit]

Taking TSO[edit]

TSO are taken orally by drinking the contents of a 30 ml bottle that has 15 ml of saline solution containing the eggs.

Taking TSO on an empty stomach will allow the eggs to move through the digestive tract a little more quickly and hatch a little earlier than if they had been delayed while a meal is being digested, but this small saving of time is the only benefit of taking them between meals. [1]

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I take mine at anytime. I do not worry about what I have eaten or time of day. TSO is bullet proof 💪 [2]

Available dose sizes[edit]

  • 500 ova
  • 1,000 ova
  • 2,500 ova

Dividing doses[edit]

Small doses of TSO can be created easily by dividing the contents of a bottle containing a larger dose. For example, after first shaking the bottle to evenly distribute the organisms it contains, doses of 500 TSO can be created from a bottle of 1000 TSO by carefully pouring out half of its contents. But, if using a bottle of 2500 ova to create five doses of 500, it's best not to attempt to pour out a fifth of the liquid by sight. Instead, after shaking the bottle, use a medicine syringe to immediately draw up 3 ml of the liquid for each dose of 500 TSO. Similarly, doses of 250 can be created from a bottle of 2500 TSO by shaking the bottle and then immediately drawing off 1.5 ml using a medicine syringe. The bottle, containing any remaining ova, should be stored in the fridge until next required.

Recommended dosing regimens[edit]

The basic dosing regimen consists of a total of 10 doses, one dose being taken every 14 days.

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Not following the recommended schedule with TSO was a bad, bad idea. [3]

In cases of more severe or chronic disease, administration of up to 20 doses may be necessary.

Some people have found that they begin to experience a return of disease symptoms slightly before the next dose is due. In these cases, shortening the period between doses by one or two days will prevent the reappearance of symptoms.

Those who start with TSO500 or TSO1000 and do not see a significant improvement in their condition by the 5th dose, should switch to the next higher dose.

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I have seen several autistic patients showing nothing on lower doses, but as soon as they reached TSO2500 the response was great. [4]

Children under 3 years old[edit]

In this group, a physician should be involved in decisions about dosing.

Children aged 3 and over[edit]

TSO should be introduced using very small doses that are taken every 2 weeks and increased gradually over a 10 week period. These doses should be measured using a 5ml pipette purchased from any drugstore. The whole protocol will require a total of 5 bottles of TSO500 and 3 bottles of TSO1000.

Dose 1. Take a bottle of TSO500, shake this well, and then take out 3ml of the solution using the pipette, drop the liquid onto a spoon or mix it with any drink, and administer. Then store the bottle in a fridge, NOT a freezer.
Dose 2. After 2 weeks, repeat as described for dose 1, but take out 6ml.
Dose 3. After another 2 weeks, take out 9ml.
Dose 4. After another 2 weeks, take out 12 ml.
Dose 5. After another 2 weeks, give one full dose of TSO500.
Dose 6. After another 2 weeks, give one full dose of TSO500.
Dose 7. After another 2 weeks, give one full dose of TSO500.
Dose 8. After another 2 weeks, give one full dose of TSO1000.
Dose 9. After another 2 weeks, give one full dose of TSO1000.
Dose 10. After another 2 weeks, give one full dose of TSO1000.

After a further 2 weeks, report progress to Tanawisa, who will advise on how to proceed. It is often unnecessary to continue treatment following the adaptation regimen outlined above, but, if further treatment is required, most children will be able to jump to doses of TSO2500 at this point.

Young people (8 years and over) with moderate symptoms[edit]

One dose of TSO500 every 14 days.

Adults with moderate symptoms[edit]

One dose of TSO1000 every 14 days.

The elderly and those with long-term illness[edit]

One dose of TSO2500 every 14 days.

Hypersensitive individuals[edit]

Anyone with one of the conditions listed as Conditions that require a modified approach to helminth dosing should start by trying very small doses. One individual with total food intolerance, and another with a mast cell disorder, each took two doses of just 250 ova (one tenth of a normal TSO dose) and experienced such severe side effects that they were unable to continue with the treatment at this dose level. They have yet to report whether they have tried even smaller doses.

Special applications[edit]

Small doses of TSO (see Dividing doses, above) can be used for a number of additional purposes, including:

  • as a temporary replacement for a different helminth, if access to that species is reduced. For example, when one self treater who had been using NA to treat IBS was unable to have hookworm doses shipped to his home in Brazil during the 2020 Covid-19 pandemic, he tried taking a very small dose of TSO and was very pleasantly surprised by the results.
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4 days after swallowing a small dose of TSO (250 ova), I am feeling much more relieved of my diarrhea, which had been punishing me for 2 or 3 months, since I accidentally ingested coconut oil, which probably killed a good part of my NA colony. [5] [6]

Side effects[edit]

As with other helminths, TSO may cause transient side effects when first introduced but, with this species, they are usually mild and limited to the period immediately following the first dose.

Gastrointestinal symptoms[edit]

Temporary, mild gastrointestinal symptoms, especially diarrhoea and mild spasms, are the most typical side effects.

Diarrhea / diarrhoea[edit]

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TSO caused me a few days of looser stools and a rumbling gut, then it settled down around the 4 to 5 day mark. [7]
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I started with 2500 TSO fortnightly from the outset (for UC). The only side effects I had were one day of mild diarrhoea 3 weeks in. [8]

In a few cases, diarrhoea can be more prolonged.

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I did have diarrhea for a solid month at dose 2. [9]

Gastritis / reflux / nausea[edit]

A few individuals have experienced gastritis following the introduction of TSO, and this appears to mostly affect those who had a prior tendency to reflux/GERD, or to gastroparesis.

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I am on TSO for about 6 months, after difficult start I was upping the bi-weekly dose by 100 to max 800 which caused me a whole week of nausea. Previous to that I was on 500-650 for about 2 months. So I returned to about 500 and that seems to be the best dose for me at the moment… but what worries me is the remarkable worsening of the gastritis. [10]

Another individual, who has reported elsewhere that she believes she had “silent reflux” for a number of years prior to taking TSO,

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I had reflux develop while on the therapy. I have now killed off the worms. Reflux has subsided considerably but still active. So I’m not 100% if it’s causal. [11]

This side effect, which is also sometimes experienced by users of NA, usually only manifests temporarily during the initial immune activation phase following the first introduction of the helminth, but it can occasionally persist for longer.

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It took longer than expected (months) and it still flares on occasion. [12]

Skin manifestations[edit]

Rarely, the skin may be affected temporarily, or there may even be some redness in the throat, after first taking TSO. [13]

Some people can be sensitive to the low pH of the phosphate-buffered saline solution in which TSO are suspended (pH 2.4 - similar to the pH of Coca Cola), but any skin response should resolve quickly, and can be prevented by mixing the TSO with Gatorade, which dilutes the fluid and raises the pH value.

Flaring of existing diseases[edit]

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I became more agitated with TSO and had more obsessive thoughts. [14]
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So, tomorrow I take dose 2 of TSO... My chronic sinus/eustachian issues seem to be flaring. [15]

Recapitulation of old injuries and illnesses[edit]

As is also the case with NA, TSO may trigger a temporary recapitulation of old injuries and illnesses.

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I'm in the middle of week 3; I did 1000 for the second dose since 500 went fairly well. I have noticed old things flaring up...a wrist injury for dropping a barbell 8 years ago; my interstitial cystitis - which has been quiet for 4 years - flared back up with a vengeance at the end of week 1 and is now settling down; a knee issue I had on and off that was probably part of my overall autoimmune landscape was bothersome for a few days. My colitis is a little flare-y, too, a little blood, gas, and mucus. That, too, is settling a little as of today. Nothing really alarming, although the cystitis was unpleasant. [16]
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The one sort of weird thing is an ache in my teeth in areas where I’ve had crowns or other dental work before. It’s not bad, it’s just something I’ve noticed each time I take TSO. [17]

Changes in dreaming habit[edit]

The following reports are from someone who introduced NA at the same time as TSO, so may be due to the hookworms rather than the whipworms.

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I had another crazy dream. I am really active in these dreams. Running and jumping and crawling and things (that) ankylosing spondylitis has made it difficult to do these past 2 years. [18] Lots of dreams about food! (I eat a restricted diet.) [19] More crazy dreams. I was sprinting with a group of people between buildings. These dreams seem to happen every night since the 1250 tso dose. [20]

Side effect occurrence[edit]

Any side effects that are experienced usually occur after the first dose, or the first few doses, decreasing in severity with each successive dose. Sometimes however, side effects may only appear after the third or fourth dose, as happened in the following case.

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My third and fourth doses were the worst. I had a lot of cramping, fatigue and diarrhea. I'm now on dose 5 and so much better. [21]

Side effect persistence[edit]

Occasionally, brief side effects may continue to appear after each of the first few doses but they gradually reduce in severity and should eventually cease.

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I just took my 4th dose (of 2500 TSO to treat ulcerative colitis)… I’ve had some gas issues for the first couple days after the doses. [22] [23]
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I’m at 1 month and 3 doses of TSO (treating rheumatoid arthritis and several other conditions). With each dose I have a small bounce followed by a flare on day 3 or 4 with loose bowels. Then my system seems to regulate to what feels like a new normal. [24]
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In the first few months I had reactions (looser stools) with each TSO dose. Once my gut healed sufficiently, within 3-4 months, I no longer had any negative reactions, yet I still continue to feel the Bounce for several days with each dose. [25]

Rarely, a TSO user may experience mild side effects following all doses in the long term.

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I do get diarrhea the day after dosing. It clears in less than 24 hours. [26]
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I feel fine after 3 days of gut upset. [27]
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I have Crohn's. I don't get nausea but I will get diarrhea after every HDC or TSO dose. It usually is the 2nd day after swallowing them. Rarely lasts into the 3rd but If I am traveling, I don't risk it. [28]

The effect of adding other species too soon[edit]

The risk of initial side effects is increased if additional helminth species are introduced for the first time while still only in the early stages with TSO.

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I’m one month post inoculation with 5 HW and one week post inoculation with 2500 TSO. I totally underestimated how bad worm flu would feel. It’s hard not to give up. I feel like I’ve been hit by a truck! [29] [30]

More detail about possible side effects[edit]

The following study looked more closely at possible side effects after taking TSO.

Avoiding side effects: the adaptation regimen[edit]

Anyone who is concerned about the possibility of side effects can start with a lower dose and build up gradually to doses of 2500.

  • Two doses of TSO500, followed by
  • two doses of TSO1000, and then
  • six doses of TSO2500.
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I was nervous about TSO so I started with 500 then quickly moved up to 1000 and then 2500. I’ve had very few side effects. [31]

If someone who starts with doses of 2500 finds that these cause diarrhoea or other side effects, they should switch to this adaptation regimen.

(See Dividing doses above for how to split larger doses into several smaller ones.)

If side effects are experienced at any stage of the adaptation regimen, that stage should be continued until the side effects have completely resolved.

If a patient is being cared for by a helminthic therapy-aware doctor, the latter may prescribe a short course of prednisone with a suitable taper. This treatment will usually allow the patient to take full doses of 2,500 TSO without experiencing any side effects.

Response to TSO[edit]

The conditions that appear to respond best to TSO are Crohn’s disease, ulcerative colitis, autism and lupus. [32] TSO can also be effective in food allergy, contact allergy, rheumatoid arthritis, multiple sclerosis and lichen planus (see more here), and it is worth trying for any autoimmune disease, or any condition with an inflammatory component.

Due to the considerable variation in how individuals respond to TSO, it is not possible to predict an accurate timeline that applies to all patients. However, it appears that around 80 percent of patients eventually respond positively to the treatment, although response and remission may take longer in the case of more severe or chronic conditions, or when individuals have been using a different helminth, such as NA, before commencing treatment with TSO. [33] [34] For this reason, anyone who is unsure which helminth species to use should ideally start with TSO, then add, or switch to, TTO, NA or HDC at a later date, if necessary. [35]

Most people notice the first improvements between the 4th full dose of 2500 TSO (i.e., after 8 weeks) and the 6th full dose (after 12 weeks), and typically achieve remission after dose 10 (i.e., 20 weeks after commencing the treatment). However, response times do vary, and more than 10 full doses may be required in the case of patients with very severe or chronic disease. [36]

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I saw improvement after the 4 doses, about 8 weeks. [37]
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I am about 4 doses in and am just now feeling some improvement with UC symptoms. I have had some other changes like less joint pain, good sleep and less inflammation but just this past week I’d say I have fewer UC symptoms. [38]
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It took me until about the 7th dose (14 weeks) to feel better. [39]

Experience gained from the use of TSO in thousands of patients over more than a decade, both in and outside clinical studies, suggests that the earlier in the disease process that treatment is initiated, the more rapidly it will work and the longer remission is likely to last once it has been achieved.

If patients stop treatment after remission is achieved, they don’t usually relapse again for between 1 and 3 years and, if they do flare again, resuming dosing with TSO will result in a return to remission. It is recommended that those who do flare again should take a periodic maintenance dose, for example 1 dose of TSO500 every 6 or 8 weeks.

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I no longer have to take TSO every 2 weeks. I take a dose (half a bottle of 2500TSO [40]) every couple of months. [41]
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I just take 500 ova (from a bottle of 2500) every two weeks. That’s all I need to maintain pain relief. [42]

A few patients may need longterm treatment with TSO, and multiple sclerosis is one condition that may require this. Eczema is another, although this is dependent on how effectively the immune system can reset itself under the influence of the TSO. [43]

An even smaller number of patients may need to continue to take medication alongside TSO in the longterm.

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I have had success only while taking TSO plus Humira. Humira alone does not make my Crohn's improve. Same with TSO. The combination seems to put me in clinical remission. [44]

One of the benefits of using a short-lived non-human helminth such as TSO or HDC is that, in comparison with the human-adapted helminths, NA and TTO, it is easier to experiment with the size and frequency of doses to find the optimal regimen for each individual.

Storage and survival of TSO[edit]

The doses of TSO supplied by Tanawisa are suspended in 15 ml of solution containing very small quantities of salts: 0.6 g of potassium chloride (KCl), 11g of sodium chloride (NaCl) and 16g of sodium phosphate monobasic dihydrate (NaH2PO4*2H2O) per 2L of distilled water. [45]

TSO is a very robust organism that can remain viable in soil for up to 9 years while exposed to all types of weather condition, from extremely cold to very hot. [46]

After receipt, TSO should ideally be stored in a fridge, and this is especially important once a bottle has been opened, since the cold will inhibit any bacterial growth. [47]

If stored in a refrigerator, TSO doses can remain viable for a couple of years, making it possible to take advantage of cheaper multiple packs, and to keep doses in reserve - something that is not possible with HDC (see Storage and survival of HDC) or NA (see Hookworm larvae storage and survival).

The excellent longevity of stored TSO, and the fact that it usually produces results more rapidly than TTO, make it ideal to be kept in reserve by users of NA for use in the event of the loss of their colony, or an interruption in benefits following the use of certain medicines and foods. (See the Human helminth care manual.)

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I keep TSO for emergencies, such as, if I have to take antibiotics, or I accidentally ingest something that harms my (human) helminths. [48]

Where do TS live?[edit]

In humans, TS have been observed to settle predominantly in the caecum and the ascending and transverse sections of the colon, [49] as shown by the red text in the following representation.


mouth ➤ oesophagus ➤ stomach ➤ duodenumjejunumileumcaecumAscending colonTransverse colonDescending colon ➤ rectum

Given that TS eventually settle in the caecum and colon, it might be assumed that administration of TSO via enema might be a viable alternative to the oral route, but it isn't. The eggs need the biochemical signal provided by the sudden increase in pH from the stomach (pH1) to the gut (pH8), which triggers hatching. [50]

The question of possible TS persistence[edit]

There is very little evidence to suggest that TSO might develop to adulthood and persist in humans, and some of the evidence that has appeared lacks credibility.

The first two reports, above, both concerned single individuals. In the first, patent infection was claimed on the basis of a biopsy and, in the second, by colonoscopy and the passage of unembryonated whipworm eggs in the subject’s faeces.

The subject in the second study had previously hosted the human whipworm, Trichuris trichiura (TT), which was assumed by those conducting the study to have been eradicated following the administration of mebendazole. However, the use of mebendazole to eradicate TT is not reliable unless 100mg of the drug is taken twice daily for at least 3-5 days (see Terminating a human whipworm infection) so, in spite of the bold claim by the researchers that they were the first to report a patent TS infection in a human volunteer undergoing TSO treatment, it is likely that the adult whipworms observed in this case were TT and not TS, and that the eggs were TTO and not TSO.

In the third study, above, only a single sample of Trichuris eggs showed merely a similarity to sequences of TS.

Doctors carrying out routine colonoscopy examinations on patients who are taking TSO have not reported finding any mature TS, and none have been observed in any of the clinical trials that have used this species, even though they included hundreds of patients. To read these studies, search the following page for "Trichuris suis".

Nevertheless, it has been reported anecdotally by one researcher that individual TS might survive for as long as 6 weeks, and one TSO self-treater, who had never used any other whipworm species, claims to have seen a few adult worms, the last of which was noticed at approximately 12 weeks after her last (10th) dose of TSO. However, these worms were never confirmed to be TS, and no adverse effects were reported by the patient.

In a further case, the mother of a four year old girl who was taking TSO, but had never taken TTO, has reported seeing an intact whipworm in a potty used by her daughter. This specimen's thicker portion was a little over 1/4 inch long and the thinner section approximately 3/4 inch long. A good photograph of this worm had been captured by the mother and was seen by one of our editors, who confirmed that it did indeed appear to be a not-yet-fully-mature whipworm.

Manufacturer and supplier of TSO[edit]

The strain of TSO supplied by Tanawisa was originally sourced from the United States Department of Agriculture farms in Baltimore, Maryland, and was used in the studies by Weinstock et al, and in all other clinical trials in humans. [51]

See also[edit]

SimpleHTLogo(18x18).gif Helminthic Therapy Wiki: documenting the science, management, experience and results of helminth replacement therapy.