Loss of efficacy does not equate to loss of helminths

”I have lost my worms because of <insert any one of your choices here>, my symptoms came back after I ate <insert name of dish here>.

There have developed some myths online regarding the loss of helminth populations, particularly hookworm, due to various foods, herbal remedies, antibiotics, etc. I have read that pumpkin seeds, pineapple, coconut milk or oil, fennel, cummin, tumeric, etc., etc., all “kill hookworms”.

One major example of this type of myth, and it seems a universally accepted example, was created by me. Sorry about that.

Sorry about that.

The fact is that none of these things kills hookworm or whipworms, as a simple thought experiment, or a simple experiment if that won’t satisfy you will demonstrate.

If coconut milk or oil, both staples of the diet in SE Asia, killed either hookworms or whipworms this purported property would have been identified long ago. If they, see list above, they would be used as folk remedies in places where either hookworm and whipworm are endemic. Because of poverty levels that mean no one owns or has access to either toilets or shoes, are public health issues. Having been identified long ago there would have been no market for antihelminthic drugs, and neither Albendazole nor Mebendazole would exist.

The observation of loss of efficacy is trustworthy, but the conclusion that one has therefore lost one’s worm population is not.

If you do an experiment on yourself while enjoying remission or substantial health benefits due to helminthic therapy and you drink or eat one of these things purported to kill helminths in isolation, and within 24 hours you see a return of symptoms you can only conclude you have lost efficacy.

However, we are not aware that anyone has done even this to test the idea that coconut oil or coconut milk, Substance A in this case, alone is responsible. There is a great deal more in all the SE Asian dishes we have eaten than coconut milk or oil alone.

For one to be sure that Substance A had caused the extermination of your helminth population, something distinct from a temporary or permanent loss of efficacy, the following would have to be done:

Having a confirmed population of helminths via stool test* one would have to take in isolation, or to ingest, Substance A, and;

Conduct regular stool tests or some other confirming test to prove ova production had stopped for the next two or three weeks, or;

Having ingested Substance A, collect all of the subject’s faeces for the next two or three days and to examine every particle of it to identify dead helminths in the subjects stool.

Even then it may be the effect of dead helminths, however unlikely it may be or seem, is the result of some other dietary or environmental factor.

A one off stool test looking for ova is insufficient. We know that some drugs suppress ova production, without killing worms, for weeks.

How was it decided that coconut milk, part of a meal with dozens of ingredients, was the culprit?

To decide that one of many constituents of what you eat in a day or two, and that it alone is the cause is just one issue that is problematic with the line of reasoning that coconut milk, Substance A, or coconut oil kills helminths.

The jump from loss of efficacy to assuming that this necessarily equates to the extermination of one’s helminth population is another.

Antibiotics (ABx) are an example that illustrates the problems with thinking coconut anything kills helminths, even if one demonstrates it causes loss of efficacy.

When a subject with an active helminth infection takes antibiotics the effect on helminths are well documented in parasitology texts. Ova production drops substantially for at least two weeks after completing the course of antibiotics. We have also observed in many instances a loss of efficacy associated with antibiotic use. Ova production drops to such an extent that the standard advice is that no parasite and ova test (microscopic examination of a stool sample looking for worm eggs) is reliable until two weeks after the subject has completed the course of antibiotics.

From this, I deduce two things.

A. That ova production is subdued for at least two weeks after taking antibiotics, and that therefore at least some helminths are affected by antibiotics, whether directly or indirectly being unknown.

B. Antibiotics do not kill helminths.

As implied many times to this point, people often erroneously equate a loss of efficacy with the death of their helminths.

Additionally, to determine that one amongst the many things you eat in a day or a week requires more than it is out of the ordinary, and therefore the culprit if you do experience a die off of your helminths. Who is to say it is not the result of some combination of foods or dietary items?

Loss of efficacy rarely in my experience means the death of the helminths.

To illustrate how powerful the act of writing something down in public, on the internet is, I shall here admit that it is a fiction that nitrous oxide kills hookworm. As well that I am responsible for that fiction. I am going to predict as well that making this admission will make not a whit of difference to the widespread belief that this is so.

My wife’s loss of efficacy in 2008 after eating whipped cream, all those years ago, which at the time we assumed meant the death of her hookworm population, is not borne out by experimentation.

I have tested it by inhaling a lot of nitrous oxide over the course of an hour, there is almost no limit to the lengths I am willing to go in the interest of science, and I lost zero hookworms and zero whipworms as a result.

I did get a headache, and I did giggle a lot.

Sorry, but Nitrous Oxide, laughing gas, does not kill hookworms.

So why would one of the breakdown products of the digestion of either coconut oil or coconut milk harm helminths?

Neither hookworms nor whipworms feed on your intestinal contents; they feed on us. Digestion is a process in which a large variety of large and small molecules are broken down into a small variety of smaller ones.

Further enzymatic degradation by the liver starts immediately of many of the products of digestion. That process is how the body can deal with what is an enormous variety of exotic molecules that we routinely take as drugs or eat as food additives.

So if you experience a loss of efficacy don’t assume it means your helminths are dead. Don’t attribute that loss of benefits to anything without very clear evidence that it is a particular thing amongst the many you ate, inhaled, etc., in the previous few days, or weeks.

Use common sense, think about the areas the food comes from and whether helminths are a public health problem in those areas.

Remember that to harm your helminths, which feed on you not what you eat, what you eat has to result in a product of digestion harmful to helminths, but not to you.

Think about whether it is possible to isolate the food as the only possible element in what you have eaten, drank or inhaled, etc., in the period of days before your loss of efficacy with absolute certainty.

Everyone believes and will continue to believe that nitrous oxide kills helminths, that is my fault. Nitrous oxide is something we have not encountered as a species until relatively recently. It is something that is not broken down by digestion, and that would seem on the face of it to be a reasonable way to kill even primitive organisms through disruption of nerve action.

If nitrous oxide does not kill helminths then how likely is it that pineapple, pumpkin seeds, or whatever it is you are eating will kill helminths?

Arguments against antibiotic use. A few amongst very many

You have “an overgrowth” of a “bad” bacteria, so I am prescribing antibiotics to kill it”.

Is this something your doctor has told you that you have?

Have they offered antibiotics as the solution?

Did they run any tests to prove their assertion? If so compared to what is your bacterial population unhealthy? How do they know it is an unhealthy population?

If an unhealthy balance in the relative sizes of the populations of different species of bacteria is the problem in your intestines how could this state have arisen?

If an unhealthy balance in the relative sizes of the populations of different species of bacteria is the problem in your intestines how could this state have arisen?

Did one of them suddenly mutate, becoming SuperBacteria, and outcompeting all others for space in your intestinal tract, or stomach or wherever?

I doubt it.

The only ways I can think of, with my admittedly limited intellect and education, for this to happen are the following two*:

Experiencing a dysenteric illness. One in which you violently emit vomit and diarrhoea for days, denuding your entire intestinal tract of much of its microbial variety.

It is, for this reason, that it is hypothesised the appendix evolved, to act as a reservoir, the structure like that of an antechamber attached to the colon. It acts like a life raft, as an ark in Biblical terms, for enough of each species to survive to allow recolonisation of the colon once the illness has passed.

That is how important bacterial “balance” is. It also illustrates how destructive antibiotics can be, if we developed an organ to preserve microbial variety then anything that harms that variety clearly has the potential to do enormous harm.

We evolved an organ to preserve microbes and microbial variety!

Bear that in mind anytime you are told to take antibiotics and ask if you have to take them. If I am told I will get better eventually, but it will take longer than if I take antibiotics, I do not take them. I fill the prescription in case I get ill, but I do not use them unless it is clear I really need them.

The appendix cannot protect microbes from antibiotics (ABx). Nor are ABx discriminating, each type kills astonishing numbers of bacteria in terms of variety. When you take them it isn’t just that the variety you host is reduced. It is that some of those that remain will proliferate beyond all “normal” bounds, and not just bacteria exist to fill that void of course. There are various yeasts and viruses. Not just in number but likely in terms of the areas of the intestinal tract they colonise. These changes represent a profound change in the signals that the host immune system receives.

A neat segue to the only other reason I can think of is the use of antibiotics. It was long assumed that things got “back to normal” quite quickly after taking ABx, but when someone bothered to look, this is from memory and I am not going to find the citation, they stopped looking after three years, when there were changes still apparent in the microbial makeup in the subjects’ intestinal tracts.

So, to fix an issue of an “overgrowth” of this or that bacteria by killing that species and for argument’s sake probably half of the species in your intestines at the same time to restore “balance” seems to me to be absurd.

While it may produce the desired result, temporarily probably, it is also likely to further impoverish the variety of species present in your intestinal tract.

It may well fix the issue in your stomach or your colon, perhaps even in the long term. Perhaps.

But has your doctor considered or discussed with you the potential consequences in other areas of your intestinal tract?

If you are being told to use ABx in circumstances like this please consider with your doctor every other approach you can. For instance, have you tried probiotics and fermented foods?

Have you read this blog post of mine?


There is a reason small children are constantly putting foul things in their mouths. If that were deleterious to their survival odds back in the day when ABx did not exist, humans, it seems to my uneducated mind would have evolved to manifest the opposite behaviours when young.

Perhaps small children cramming disgusting things in their mouths is an evolved behaviour? Like the appendix in a way, but to ensure we acquire sufficient microbial variety, rather than to preserve it? To prime our immune system by populating our intestinal tracts with the variety of microbes required for health?

Just some things for you to consider and to discuss with your doctor/s.

*As with everything and anything I say, or write, nothing written here or elsewhere on this site should be interpreted, construed and most of all acted on as though it were medical advice. I never went to college, never mind not being an MD. Anything you read here is for your consideration and if you believe may have merit for discussion with your doctor. I am not a doctor, nothing I write here should be considered as medical advice.

*There are clearly others, a change in diet so that the food availble in various parts of your intestinal tract are changed substantially resulting in a change in microbial population.

**NOTHING I write is meant to diagnose, treat or prognosticate on any disease or illness.