Difference between revisions of "Self-treating with TTO"

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== TTO storage and survival ==
== TTO storage and survival ==


TTO are robust organisms that withstand the rigours of shipping extremely well. Once received by a self-treater, vials containing TTO should be stored in a refrigerator, ideally in a dark container. Provided that they have not been frozen or exposed to extreme heat, and that the liquid containing them remains clear rather than cloudy, TTO stored in a fridge will remain viable for a couple of years. This allows self-treaters to purchase doses when convenient and keep them in reserve till required.
TTO are robust organisms that withstand the rigours of shipping extremely well. Once received by a self-treater, vials containing TTO should be stored in a refrigerator, ideally in a dark container. Provided that they have not been frozen or exposed to extreme heat, and that the liquid containing them remains clear rather than cloudy, TTO stored in a fridge had been thought to remain viable for a couple of years, but one user has reported a drop-off of benefit from somewhere around 18 months. This is still a long period of time, however, and allows TTO self-treaters to purchase doses when convenient and keep them in reserve until required.


== Inoculation with TTO ==
== Inoculation with TTO ==

Revision as of 21:17, 13 May 2021


TTO are the eggs of the human whipworm, Trichuris trichiura (TT). In helminthic therapy, these eggs are referred to as “ova”, hence the abbreviation, “TTO”.

Once inside a human host, the ova hatch and mature to adulthood, typically surviving for periods ranging from a few months to a couple of years.

Dosing with TTO[edit]

The evolution of TTO dosing[edit]

When TTO was first introduced for sale, in 2009, it was recommended that self-treaters take an initial course of three increasingly larger doses - for example, 100, 200 and 800 ova at monthly intervals - but this level of dosing can cause significant side effects.

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It was a rough road, as I suffered definite side effects and temporary worsening each time I added a cohort of whipworms (usually beginning 2 weeks after swallowing the egg solution and continuing for 1-3 weeks thereafter) to the point that I was seriously considering stopping the therapy and killing the worms. [1]

A new approach to dosing with TTO was introduced in 2014, which used much smaller doses taken on a regular, ongoing basis, typically 25 ova every week, or 50 ova every two weeks. The dosing intervals in this approach are more in line with those used in the dosing protocol for TSO (the ova of the pig whipworm), although TTO do not die after two or three weeks, as TSO do, so the number of TTO that are inoculated are necessarily much smaller than those used in therapy with TSO.

The advantages of taking TTO more frequently, in smaller doses, are:

1. This helps to reduce the risk of side effects, and, if these do appear, dosing can be paused until they resolve.
2. A possible additional therapeutic benefit from more regular exposure to the larval stage of helminths. [2]
3. The members of the resulting colony will be at many different life stages, thus reducing the risk of a sudden return of disease symptoms due to a large die-off of older worms at around the same time.

Considerations for TTO dosing[edit]

  • Due to the relatively small number of self-treaters who are using TTO, and the consequently limited feedback on the effects of different dose sizes, dosing with this species is still somewhat experimental. However, it has been established that it is safe to inoculate with up to 1,500 ova per year - which is considered by health authorities to be a “light” infection - and that, when this number is spread across multiple doses, the serious adverse effects that are associated with “heavy” TT infections - such as bleeding and rectal prolapse - are prevented.
  • Only an estimated 10-20% of the ova in a dose of TTO will develop into mature worms, but, since it is not possible to accurately determine the hatching rate, current dosing practice is based on the number of ova in a dose rather than on a theoretical number of worms that might result from it.
  • As in self-treatment with other species of therapeutic helminth, there is considerable variation in individual response to TTO. Therefore, each self-treater needs to carefully observe their own response over time and modify their dosing practice accordingly.
  • Anyone with a lot of intestinal inflammation may be taking an immunosuppressant medication such as prednisone/prednisolone. By controlling the inflammation, this type of drug will help the worms become established. For more about this, see Combining helminthic therapy with drug treatments.

TTO dosing recommendations[edit]

Many self-treaters are likely to achieve the best results by taking doses of 25 TTO every week, or 50 every two weeks, especially when beginning treatment with this species.

However, a few people react quite strongly to even small doses. So, at least for this minority, taking 300 TTO every 12 weeks (or even larger doses at commensurately longer intervals) may provide the best compromise and limit the total amount of time spent dealing with side effects. One doctor who recommends the use of TTO in cases of ulcerative colitis prefers his patients to start with a dose of 500 TTO, based on this paper. Some patients who have commenced with this size of dose have apparently reported transient abdominal pain or other symptoms after dosing, but this has not always been the case.

It is also possible that someone who is experiencing severe colonic inflammation might benefit from taking larger doses less frequently because, while this may cause more severe side effects for a while after each dose, it might also be more effective at subduing the inflammation.

In general, if side effects are experienced after taking a dose of TTO, the next dose should be delayed until they have subsided.

TTO storage and survival[edit]

TTO are robust organisms that withstand the rigours of shipping extremely well. Once received by a self-treater, vials containing TTO should be stored in a refrigerator, ideally in a dark container. Provided that they have not been frozen or exposed to extreme heat, and that the liquid containing them remains clear rather than cloudy, TTO stored in a fridge had been thought to remain viable for a couple of years, but one user has reported a drop-off of benefit from somewhere around 18 months. This is still a long period of time, however, and allows TTO self-treaters to purchase doses when convenient and keep them in reserve until required.

Inoculation with TTO[edit]

TTO are supplied in a small vial and are taken orally, either swallowed directly from the vial, or added to a little cold or cool water. Hot drinks should be avoided for at least 2 hours after taking TTO, and taking them on an empty stomach may be preferable.

TT timeline[edit]

Days 1 and 2[edit]

Following inoculation, the ova reach the small intestine where they are stimulated to hatch by the indigenous microflora. This process may cause mild dizziness or vertigo, possibly with some indigestion and nausea.

Days 3 to 9[edit]

The emerging larvae then enter the crypts of Lieberkühn, which are glands lying between the finger-like villi that line the inner surface of the small intestine. Here, they will moult four times as they continue to grow - a stage that may not present any noticeable reaction in the host.

Day 10 to 3-4 months[edit]

The young worms emerge after 10-14 days and migrate to the caecum, where they partially penetrate the mucosal lining and complete their development into adult worms during the reminder of the first three months. They eventually spread throughout the caecum and the ascending and transverse sections of the large intestine, where the females begin producing eggs from approximately three months. Their attachment to the colon lining during this stage can cause IBD-like symptoms, described in more detail in the Possible TT side effects section below.

Where TT live and what they eat[edit]

After temporarily inhabiting the small intestine (the duodenum, jejunum and ileum) during most of the first two weeks, TT then move to, and settle in, the cecum [3] and the ascending and transverse sections of the colon, as shown by the red text in the following representation.


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

It has occasionally been suggested by ill-informed commenters that TT might mis-migrate to organs outside the intestine, but the human whipworm remains reliably within the gut. It is also not possible for TT to multiply within a host because its eggs need to be deposited in soil, where, given suitable conditions, they will embryonate after two to three weeks. It is only at this point that they become infective so, unless a user of TTO ingests further embryonated eggs, their colony will never increase.

Helminth providers who supply TTO ensure they are embryonated before shipping.

Whipworms do not feed on their host's blood. They graze on tissue secretions.

Confirming a TT infection[edit]

There are two practical options for determining the presence of human whipworms in the gut.

1. Stool test

From about three months post inoculation with TTO, the adult whipworms will begin to produce eggs that will be detectable in the host's stool. Checking a stool sample for these eggs is the best way to establish that whipworms are present. Unfortunately, while most pathology labs will have a faecal (stool) test called something like "Ova, Cysts, and Parasites" or "Ova and Parasite", they typically do not have sufficient experience to accurately identify helminth eggs, a problem that is exacerbated by the relatively low numbers of worms used in helminthic therapy. Testing is therefore best carried out by a helminth provider who offers a stool testing service, a laboratory associated with a school of tropical medicine, a veterinarian (who will have experience with helminth eggs), or at home using a microscope and fecalyzer. For more details about these options, see the following page.

2. Blood test for eosinophils

Another way to determine whether or not someone is hosting whipworms is to have a blood draw to see if their eosinophil level is elevated. Although this is not a foolproof test for the presence of helminths (eosinophils are not always raised), it is fairly reliable. It is also quick, and is a method that a medical insurer might pay for.

Caring for TT[edit]

Some substances can have an adverse effect on TT, although this species is far less susceptible to harm than hookworms. See the following page for more details.

Possible TT side effects[edit]

Any side effects encountered following inoculation with TTO are likely to be mild and limited to the first few weeks. Since they are largely dose-dependent, the side effects can be minimised by conservative dosing.

Side effects following the initial dose[edit]

It’s easy to obsess about the process unfolding in one’s gut after ingesting TTO, to wonder whether the treatment is 'taking’, and to ascribe every tick and sniffle that develops in the first few weeks to the whipworms. But one's body continues to operate largely as usual in the early stages of any helminth colonisation. One still gets colds and other infections, and any physical changes experienced by new helminth hosts are far more likely to be manifestations of normal bodily functions than the action of the helminths. Colonisation follows a natural progression determined by evolution over millions of years, and it is largely hidden from immediate experience. For at least the first few weeks, the worms will be maturing, and mostly doing this in stealth mode, especially if smaller doses are taken initially. While some side effects are possible during this time, these are generally less troublesome than those encountered after inoculation with hookworms.

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(Human) Whipworms are less upsetting (than hookworms) for me, especially with small doses of 50. Larger doses can cause bad gut cramping that lasts 24 hours then disappears. I get a nice "bounce” that lasts for about a week, joint pain, a bit of lethargy and no serious brain fog. [4]

However, some people find that TTO produces a more pronounced response than hookworms.

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I ingested 25 TTO (four days ago). My first round. I’ve been very bloated and kind of crampy/gassy since. More pronounced than with NA. [5]

Abdominal pain[edit]

Abdominal pain is possible in the first few days, possibly accompanied by gas and bloating. The pain is experienced in the lower right of the abdomen where the whipworms attach to the caecum and ascending colon. This pain may be sharp and will usually only last for a few hours, but it can recur intermittently at any point up to around 3 months, and, when it does appear, it may persist for a few days, even perhaps for a week or more in rare cases.

Asthma, exacerbation of[edit]

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I responded to 25 TTO ok, but had some slight asthma return. This just eased off over the next 3 months (no more dosing). [6]

Diarrhoea / diarrhea[edit]

Diarrhoea may occur in association with the abdominal pain, although this is less likely. In rare instances, nausea and sickness have also been reported.

Sometimes there is a worsening of the symptoms of existing diseases while the whipworms are becoming established, and anyone with ulcerative colitis or Crohn’s colitis will have difficulty distinguishing between the symptoms of their disease and those triggered by the whipworms, because both cause inflammation. A few people may get some bleeding, and any active colonic disease will make it harder for the whipworms to become established.

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I would get a slight bit of stomach ache, like indigestion but nothing major 24-48 hrs. Then all would be fine until day 13, when I would get an immune reaction kicking in. This manifests as inflammation and some blood in stool as well as liquid diarrhea. This would last for a week but would be prevented by taking prednisone.

Constipation[edit]

Constipation can be another short-term consequence of adopting human whipworms. [7] [8]

Allergies[edit]

Allergies may flare temporarily, [9] and may even cause transient allergic-type reactions in people who normally don’t have allergies. [10] These may include asthma and skin reactions or rashes, which typically start a few days after taking the ova and may continue for 3-6 weeks but are usually mild and short-lived. In a few cases, these side effects can persist for longer, even up to 8 weeks after taking TTO. [11]

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I find even a low dose TTO (25) makes me wheezy. TSO I find is OK. [12]

If necessary, NA can be hosted in addition to TT in order to help reduce the possibility of an allergic reaction to the latter and to provide additional systemic inflammation control, [13] although it is usually best to introduce one species at a time to avoid overstimulating the immune system, and to allow observation of which side effects relate to each species.

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I have Taken 3 doses of Whipworm so far (25 per dose) the only thing I notice so far is achy hands & feet. My feet tend to bother me when I am in a full blown flare but not my hands. [14]

Insomnia[edit]

Occasionally, new hosts of human whipworms will report periods of insomnia, sometimes lasting for several weeks, and some other conditions may flare temporarily after taking TTO, including herpes. Someone who already suffers frequent or severe outbreaks of herpes may see these worsen and increase in frequency for up to three or four months after inoculation with TTO, [15] before returning to the pattern seen before inoculation. (See Helminthic therapy and herpes.)

Mucus production, increase in[edit]

This “side effect” can be very beneficial and form part of the solution to treating some conditions, for example, inflammatory bowel disease.

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We propose a model whereby the immune response that is triggered to expel gastrointestinal parasites, which includes increased mucus production, changes to the composition of mucus secreted by goblet cells and increased epithelial cell turnover, may have a beneficial effect in restoring mucosal barrier function during inflammatory bowel disease and reducing inflammation driven by gut bacteria. [16]

TTO self-treaters have reported as follows.

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I’ve defiantly noticed a increase of mucus after three months of TT0. [17]
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Experienced a massive increase in mucus in stool after having TTO onboard… have been hosting for about 5 months and it is still very persistent. [18]

Oral symptoms[edit]

Lingua geographica (geographic tongue) can develop following a dose of TTO [19] or NA [20], and may be due to a microbial change in the mouth.

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Another inoculation and again Lingua Geographica for me! Also again reduced dental plaque. This time the inoculation was with TT. [21]

Two TT hosts have also experienced a further oral phenomenon when taking their third doses of TTO. They reported independently that the liquid tasted “bad”, as if it were spoiled, but neither user suspected that their dose had been contaminated because they had both purchased 9 doses at one time and none of the others caused the bad taste they experienced with their third dose.

Psoriasis-like skin eruption[edit]

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I got some novel and worrying patches of psoriasis after adding TTO. It came on fast, and was quite surprising. But it did resolve in a couple of months, and hasn't been a bother since. [22] [23]

In general, any side effects following inoculation with TTO are likely to be mild, subside quickly, and be easier to cope with than those experienced by hosts of NA, but side effects can appear intermittently for up to three or four months, or even longer in rare cases.

See also[edit]

For further insight into the short-term side effects that are possible after inoculating with TTO, see the following paper concerning the side effects experienced by subjects who inoculated with the closely related species, TSO.

Side effects from supplementary doses[edit]

The side effects following supplementary inoculations with TTO typically become less severe with each successive dose.

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I had light side effects with TTO. On doses 1-3, I had some diarrhea, but by dose 4, I was diarrhea free. [24]

In a few people, side effects may continue to appear briefly after each new dose in the long term, especially in those who are taking larger doses.

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Whipworms have much less side effects (than hookworms), for me, and last a month at the very extreme. I can take a dose of 500 human whipworm and the side effects last a week (5 days). Mostly gut upset then I'm back to my usual self. [25]
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I've noticed that I am gassy and bloated for a day or 2 after ingesting my TTO but not every time. I have no other side effects. [26]
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I find I get a transient return of symptoms around 5-8 weeks post TTO inoculation. [27]

There is an extremely small possibility that therapeutic doses of human whipworms might cause anaemia (anemia) over time. However, the type of anaemia involved may not due to low iron levels, so might not respond to treatment with iron supplements. It has been speculated that this form of anaemia might be due to active suppression of the formation of blood cellular components in the bone marrow, rather than as a result of bleeding. The likelihood of this phenomenon occurring in someone using therapeutic doses of human whipworm is thought to be vanishingly small, and, if it were to occur, it may - according to one physician member of the helminthic therapy community - be amenable to remediation by taking Erythropoietin (EPO).

Treating the side effects[edit]

Side effects encountered after inoculation with TTO can be treated using whatever appropriate over-the-counter or prescription medicine is available, as directed on the packaging or by the prescribing doctor. What works to calm hookworm side effects will also effectively relieve those caused by whipworms.

Therapeutic response to TT[edit]

Once the TT host has got past any transient side effects, s/he can look forward to the possibility of significant benefits.

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I am finally in UC remission and and have been now for about 3 weeks… I have also been taking Humira for about ten months, but Humira alone never got me into full remission or off prednisone - indeed its effects never even lasted completely between doses until the apparent "kick-in" of human whipworms took effect. The big improvement coincided almost exactly with 5 monthsish from the start of human whipworm therapy. [28]
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I am off all drugs for my colitis which has been so bad at times 8 pentasa a day wasn't working and even prendizone started to be less efficient! It's been a year since starting human whip worm and i'm feeling amazing, off drugs as of 2 weeks, hoping to hold my helminth community and monitor keeping an amazing quality of life i have back!! [29]
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From 3 weeks onwards, I would see slow improvement. I put on weight, bleeding had stopped, iron levels improved as did inflammatory blood markers, urgency was down so no more dashing to the bathroom in an emergency.

The benefits of hosting TT can often be enhanced by combining this species with hookworms.

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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. [30]
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I was diagnosed with UC in 2000 at age 24. I suffered for quite a while, trying western, eastern... all kinds of therapies. Then, in 2012 when I was absolutely miserable, I happened upon the Radiolab podcast about Parasites. I have been using NA and TTO since. They have changed my life. For example, when I was sick, I had terrible joint inflammation and couldn't lift the phone to call in sick. Three weeks ago, I went on a two day extreme mountain bike tour up and down the mountains of Guatemala. [31]

For more on combining TT and NA, see Selecting a therapeutic helminth: TTO.

TT lifespan[edit]

Once TTO have been ingested, these helminths can survive in humans for more than 2 years, and there have been two reports of them being seen during a colonoscopy at 7 and 8 years post-inoculation. However, their longevity is determined by the strength of the individual host’s immune response, and they may not survive past the first year in some people.

TT incubation[edit]

TTO can be incubated at home, although this requires more equipment than hookworm incubation, and the process takes longer and is technically more challenging. See the following page for full details.

See also[edit]