Are we too clean for our health? That's the theory behind a surprising (and growing) area of research. Doctors and scientists are exploring the use of helminths—more typically known as parasitic intestinal worms—to treat a range of ailments, from inflammatory bowel diseases like Crohn's disease and ulcerative colitis to severe seasonal allergies and asthma to neurological disorders, including multiple sclerosis and even autism.

The thinking is this: Throughout history and in the normal course of our lives, humans have had lots of contact with creepy critters like helminths-in fact, to the point that some helminths are exclusive to humans, meaning that they grow and reproduce only in our systems. However, we've gotten much cleaner these days-with our indoor plumbing, antimicrobial cleansers, frequent laundering and bathing and, in many areas, less exposure to farm animals. This means we now share our homes and bodies) with far fewer of these tiny, unseen creatures. Meanwhile the same time line has brought an increase in the incidence of inflammatory bowel diseases, asthma, seasonal allergies and the like-problems related to an overreactive immune system. Interestingly, these diseases are still uncommon in countries that don't have hygiene standards similar to ours.

The Hidden Connection

Could there be a connection? Scientists are exploring the possibility that helminths play a role in the healthy human immune system—and it appears that there may be some merit to this odd (and frankly unpalatable) theory.

Joel Weinstock, MD, a professor of immunology at Tufts University School of Medicine in Boston is a leading expert on this topic. According to Dr. Weinstock, we should all be aware that there are two major functions of the immune system. Most people are familiar with one-the "fight and kill" response. "But what would happen if you got an infection in your arm and your immune system didn't know when to turn off? That generally doesn't happen because the immune system's regulatory aspect kicks in," he explained. This self-regulating aspect is what gets out of whack in people with conditions like inflammatory bowel disease, in which the mucosal immune system perceives organisms in the gut as much more dangerous than they are—and then attacks them. This same premise also applies to other immune system-related problems, such as asthma, allergies and the like.

Where do the worms come in? Helminths can help regulate an overreactive immune system, Dr. Weinstock explained. Some of his group's early research appears to support this theory, at least in the case of inflammatory bowel diseases: A randomized controlled trial using Tricburis suis (pig whipworm) therapy for ulcerative colitis found an improvement in symptoms in 43.3% of those receiving the whipworm treatment, as opposed to 16.7% given the placebo. A similar study for the treatment of Crohn's disease showed similar results. In fact, Dr. Weinstock said those studies showed so much promise that helminth therapy is now being studied for other conditions-including a clinical trial currently getting started that's going to explore using helminths in patients with multiple sclerosis. (Meanwhile, another recently completed trial found that whipworm was ineffective as a treatment for pollen-induced allergic rhinitis, so don't be surmising that this particular organism works for everything!)

What’s Not So Great

Apart from the "ick factor," there are valid concerns about the growing interest in helminth therapy-most particularly that some unscrupulous human opportunists are worming their way onto the market to peddle parasites that could, in fact, turn out to be quite dangerous. Though he is optimistic about the potential of helminth therapy, Dr. Weinstock points out that an FDA-approved helminth-based treatment is still years away at best...but, because these parasites occur naturally in the wild, some enterprising individuals are already selling them to the public. This could bring more harm to patients who are already vulnerable and suffering, not to mention to the reputation of this promising therapy.

"These products are not monitored or approved by the FDA," Dr. Weinstock says. Many parasites look enough like each other that only a scientist can distinguish among different strains and species, so there is no way for a consumer looking at a Web site hawking parasites to know what is actually delivered. "It could be salt or sugar-or worse, you could end up with a treatment that is worse than the disease-because some parasites (unlike pig whipworm, which is relatively harmless) can be very harmful," he points out. With no oversight and no certification or standards, there is no way to know that what you're buying is safe, let alone effective against a particular complaint.

If you are a person who does happen to have inflammatory bowel disease or another of the immune-related diseases for which this therapy might be helpful, is there any safe, reliable way to try parasite therapy? Dr. Weinstock offered these important cautions...

  • Don't go it alone. "This applies to any alternative approach," he says. "You want to have an expert in the disease work with you to make sure that you don't do any harm." This is a situation where it is a good idea to enlist a physician who specializes in your disease and can help guide the therapy.
  • Try established, proven therapies first. Before trying helminths, make sure that you and your physician have considered all the conventional therapies, since these less controversial treatments have been proven beneficial for many and are far more straightforward, at least at this point in time.
  • Look for clinical trials. If you are interested in going forward, the best place to find opportunities to do so safely is to explore clinical trials and studies, most of which are announced through the nonprofit societies that support disease research, such as the National Multiple Sclerosis Society. You can also find them at www.clinicaltrials gou. Another resource for information and research is the site of the manufacturer of the whipworm used in the earlier studies,

This ancient "medicine" may someday become conventional again, but it's not to be undertaken casually. Stick with resources you know to be clean and safe, "above ground" in every sense of the term.

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