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
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. 
Available dose sizes
- 500 ova
- 1,000 ova
- 2,500 ova
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
The basic dosing regimen consists of a total of 10 doses, one dose being taken every 14 days.
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.
Children under 3 years old
In this group, a physician should be involved in decisions about dosing.
Children aged 3 and over
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
One dose of TSO500 every 14 days.
Adults with moderate symptoms
One dose of TSO1000 every 14 days.
The elderly and those with long-term illness
One dose of TSO2500 every 14 days.
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.
Small doses of TSO (see Dividing doses, above) can be used for a number of additional purposes, including:
- to complement therapy with a different helminth species. See Hosting multiple worm species.
- to help modulate the severity of the skin response to inoculation with NA. See, Adding a small dose of TSO.
- 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.
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.
Temporary, mild gastrointestinal symptoms, especially diarrhoea and mild spasms, are the most typical side effects.
Diarrhea / diarrhoea
In a few cases, diarrhoea can be more prolonged.
Reflux / nausea / gastritis
These side effects, which are also sometimes experienced by users of NA, usually only manifest temporarily during the initial immune activation phase following the first introduction of a helminth, but they can occasionally persist for longer, especially in those with a prior tendency to reflux/GERD, or to gastroparesis.
Another individual, who has reported elsewhere that she believes she had “silent reflux” for a number of years prior to taking TSO, has reported as follows.
Rarely, the skin may be affected temporarily, or there may even be some redness in the throat, after first taking TSO. 
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
Recapitulation of old injuries and illnesses
As is also the case with NA, TSO may trigger a temporary recapitulation of old injuries and illnesses.
Changes in dreaming habit
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.
Side effect occurrence
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.
Side effect persistence
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.
Rarely, a TSO user may experience mild side effects following all doses in the long term.
The effect of adding other species too soon
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.
More detail about possible side effects
The following study looked more closely at possible side effects after taking TSO.
- Symptoms after Ingestion of Pig Whipworm Trichuris suis Eggs in a Randomized Placebo-Controlled Double-Blind Clinical Trial -- Full text | PDF
Avoiding side effects: the adaptation regimen
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.
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
The conditions that appear to respond best to TSO are Crohn’s disease, ulcerative colitis, autism and lupus.  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.   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. 
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. 
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.
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. 
An even smaller number of patients may need to continue to take medication alongside TSO in the longterm.
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
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. 
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. 
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. 
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.)
Where do TS live?
In humans, TS have been observed to settle predominantly in the caecum and the ascending and transverse sections of the colon,  as shown by the red text in the following representation.
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. 
The question of possible TS persistence
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.
- Iatrogenic Trichuris suis infection in a patient with Crohn disease
- Immune responses and parasitological observations induced during probiotic treatment with medicinal Trichuris suis ova in a healthy volunteer
- Molecular Identification of Trichuris suis and Trichuris trichiura Eggs in Human Populations from Thailand, Lao PDR, and Myanmar
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
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. 
- The safety of self-treatment with TSO
- TSO compared with the other therapeutic helminths
- Suppliers of TSO and other therapeutic helminths
- Personal stories from users of TSO and other helminth species. Use the search function on your device (Control+F, or Command+F on a Mac) to search the page for "TSO".
- Provider's instructions for the use of TSO