More evidence of the power of ecosystems

Just read at the second pass by an interesting article on the Independent.co.uk, a national newspaper in the UK concerning a recent discovery. Scientists claim to have worked out why honey is so good as an antibiotic and it has nothing to do with honey bees directly, but rather the ecosystem formed by their stomachs, as with us and helminths and the hygiene hypothesis/old friends hypothesis. Turns out they believe that bacteria living in honey bee stomachs is what confers the antibiotic properties on honey. I will leave it to your imagination how bacteria in a bee’s stomach transfer that power to the honey you enjoy. But yet another, they are stacking up fast, demonstrating that thinking of ecosystems on any level as separate or distinct from one another is not productive. Although the hippy connotations have always bothered me I think Gaia deserves another look, and hopefully a better name with less mystical associations.

From the Independent:
For millenia, raw unmanufactured honey has been used to treat infections.

Scientists believe its effectiveness could lie in a unique formula comprised of 13 types of lactic acid bacteria found in the stomachs of bees. The bacteria, which are no longer active in shop-bought honey, produce a myriad of active anti-microbial compounds.

….

Honey has long been known, centuries in fact, to have extraordinary antibiotic properties. It’s the bacteria in the bee’s stomach…


By applying the bacteria to pathogens found in severe human wounds – including MRSA – scientists from Lund University, Sweden, found that the formula from a bee’s stomach successfully counteracted the infections.

Researchers believe that the formula works so potently because it contains a broad spectrum of active substances, unlike conventional man-made antibiotics.

My only sadness was in reading that the active ingredients had been killed by the time it is bought, honey must be pasteurised. Doing so would not just kill any bacteria but denature any ESMs left behind in the honey.

If you want the benefits you would likely have to eat raw honey. But one to store away for after the zombie apocalypse.

http://www.independent.co.uk/life-style/health-and-families/health-news/bacteria-found-in-honeybee-stomachs-could-be-used-as-alternative-to-antibiotics-9724292.html

Another great result for Crohn’s, this time in an adult

In his words, edited to remove any identifying phrases or words:

“Today marks exactly <b600 (Jasper, while it did not take this long for him to respond, he was slow to respond as I recall, and this should be born in mind by anyone on or considering therapy) days (20 months) since I have taken immunosuppressive medication of any kind. I suffer moderate to severe Crohn’s, since 2006. I dosed with hookworm late 2010 (22 months ago), and twice in 2011. After three doses totalling 150 worms, I estimate that the hookworm alone achieves 85% symptom relief for me. I rejoice at the phenomenal benefit to my life. It would be no exaggeration to call my case a small miracle. I hope to continue to experience this degree of relief.”

No drugs, quite a result, and not atypical.

One reason among many patent reform is needed

Patent: Further information: Association for Molecular Pathology, et al. v. United States Patent and Trademark Office, et al.

Methods to isolate and detect BRCA1 and BRCA2 (Breast cancer genes) were patented in the United States by Myriad Genetics. (So just so everyone is clear, this company has effectively patented a part of the human genome, human genes. There are lots of examples of this kind of idiocy, including famously a Texas company patenting Basmati Rice and then seeking to prevent Indian & Pakistani growers from selling their rice under the name Basmati any longer in jurisdictions covered by the patent).

This US patent has been challenged by the American Civil Liberties Union. On March 29, 2010, a coalition led by the American Civil Liberties Union ACLU successfully challenged the basis of Myriad’s patents in New York District Court. The patent was invalidated, but the decision was appealed.

On July 29, 2011 the United States Court of Appeals for the Federal Circuit made their decision and ruled that Myriads patents are valid.

Effect on Gene Testing
The conditions of Myriad’s BRCA patent require that the only laboratories legally allowed to test and sequence the genes are the ones affiliated with Myriad. This exclusive control over BRCA testing, guaranteed by the patent, has prevented peer-reviewed validation of the tests provided by Myriad.

Since the BRCA test is marketed directly to the consumer, it is not subject to government oversight by agencies like the FDA.

Without this government review, gene tests must be studied and assessed by scientific colleagues in a peer review. However, the kind of studies needed to validate the tests require access to the BRCA genes, which are protected by Myriad’s restrictive patent. (Is this funny, tragicomic, enraging, befuddling, ludicrous, or just the free-market?)

Thus, without access to the genes (meaning you cannot even study them without paying Myriad a patent license fee, assuming they are willing to grant it, in the USA – like I said, you could not make this up) or the methods used to sequence them, peer review of the test’s effectiveness is virtually impossible. (here I have to disagree, it is impossible unless you pay Myriad for the use of their patents to study their methods to determine if they are actually effective. Genius, I wish I had a patent on you.)

However, the patents have yet to be enforced in Europe, where BRCA research and testing is becoming more widely available, and several laboratories are currently offering their own BRCA testing. The UK firm NewGene offers the test at a very competitive price, to the NHS, its owner, only. (Equally surreal and non-sensical, of course. But cheaper…)

Legal decisions surrounding the BRCA1 and BRCA2 patents hold particular bearing on the field of genetic testing, as the field is relatively young. Until legal guidelines can be applied to the practice of gene testing, progress in the field will likely suffer due to uncertainty. Any decision made regarding the BRCA patents will likely become precedent for future disputes over the use of genes for testing.

via BRCA1 – Wikipedia, the free encyclopedia.

Facebook Page for Helminthic Therapy

Hi, we have long had a well maintained and regularly updated FB page, fed in part via our Twitter account. It gets a lot of activity, daily, with links to news, etc.,

To visit go here, and if you just want the twitter feed the address is @wormtherapy (@helminthictherapy was too long, as much as I dislike the term worm therapy it was that or nothing.).

I hope you find these resources useful.

What is corruption?

When I still lived in the US and Sani Abacha was the suddenly the dead ex-president of Nigeria, and it was therefore discovered he had looted billions from the Nigerian treasury, some of my friends in the US were aghast at the scale of his corruption. Apparently they did not read much international news, or much news at all perhaps.

My comment was “At least their leaders get a decent price”,  being of the view that to sell your constituent’s interests out to lobbyists in exchange for providing you the means to retain your position, as what, at the next election so you can repeat the process lacks ambition, any understanding of pricing, as well as integrity. That seems to me to be an accurate description of the relationship between lobbyists and the politicians they fund in America.

As I say, at least Mr. Abacha got a decent price for his integrity.

Which perhaps partially explains this map. One of world corruption based on the research and perspectives of those who prepared it. As the title asks, what is corruption?, so must have the map makers. How corruption is defined and measured, which varies with time and place of course, and who does the measuring. These fundamental things have an enormous impact on the results in such an exercise.

I think they missed most of the endemic corruption woven into western economies, of the type above and below. Corruption, after a great deal of practice in the developed world, has been refined to either a state of invisibility through familiarity. Or one of a pantomime everyone uses to pretend to themselves that this is just the way things are, or for a minority, to ensure they remain so.

But in any case it is legal when practiced on any scale worth studying, or mapping, in the light yellow or orange countries on that map. But if it is legal then it does not appear on this map. A kind of Catch-22, or of corruption all of itself really.

When thinking of really big examples the Bush sponsored Medicare Prescription Drug Improvement Act still comes to my mind first.

An Act that on the one hand makes prescription drugs cheaper and more available to seniors enrolled in Medicare. Old lady’s arthritis pills, what is not to like there? Within a contorted system of plans and rules it should be noted.

An Act that also expressly forbids the United States Government, the largest buyer of prescription drugs in the US, from negotiating lower drug prices from drug companies. Take a moment, let that sink in. Within a very simple system it should be noted.

This seems, to me, like it might be an example of corruption.

But not according to this map.
http://media.transparency.org/maps/cpi2013-640.html

Senator Hillary Rodham Clinton (Democrat, New York) announced that she is working on legislation to improve the Medicare drug benefit by creating a regulatory structure to find and remove less-efficient private drug plans.  She also said that the government should have the authority to negotiate for lower drug prices in Medicare (which is strongly opposed by the pharmaceutical companies) and that pharmacists should be reimbursed for filling prescriptions for Medicare beneficiaries who were unable to prove eligibility because of computer glitches; and the February 15 deadline for reimbursing states offering Medicaid coverage to address coverage gaps should be extended - Link to source

When the custom was to speak plainly I think this was referred to as price rigging. But as with IQ tests, or SAT scores, or law enforcement, test results tend to provide as comfortable outcome as possible for those designing or administering the rules or laws, and more so as time passes. Intelligence declining according to historic measures? Grades and scholastic aptitude measures in decline? Too many of your friends prevented from expressing their desires by unreasonable limits imposed by a different interest group?

Don’t cheat, don’t break the rules or laws, that is corrupt. Change them, that is democracy.

In the more specific example below, as shown in the accompanying screenshot from my unsubscribe form submission with WebMD Professional, you can see mention of this type of legal corruption that few seem to see because it is part of the fabric of life. In this case it was a piece of that fabric I had not seen before, so it was shocking.

After unsubscribing I was asked the reasons for my leaving, and other questions WebMD thought might provide useful answers.

The most interesting to me was: “Do you only participate in programs sponsored by pharmaceutical companies when an honorarium is offered”.

I did not know that it was common, and legal, practice to pay doctors to listen to drug companies make presentations, did you?

I suspect that this information is presented either alongside, or perhaps even as, research or continuing education requirement courses offering credit to doctors who have to submit evidence they are keeping abreast of academic advances in their field. After all what else but interest or compulsion would make you travel across the country and stay in a hotel with a bunch of doctors, and attend a conference and it’s presentations and discussions?

Honorarium, far more mellifluous a word than any accurate alternative. Some examples? Substitute “bribe” or “inducement” in place of “honorarium” and the question would be as accurate, and more honest.

Paying someone to attend, no mention is made as to whether honorariums on average defray, meet or exceed the expense of attending for instance. Or that they are only offered if the party paying expects to profit from the act in some way. That might be by gaining a reputation as a sponsor of worthy causes I suppose. But these are drug companies paying doctors after all, and drug companies are first for-profit, not for-health, enterprises. What do you think the odds are that this practice is so widespread that it is regulated?

How large are honorariums, how do they vary, is there any correlation between the size of the payment and the market potential of the drug in dollar terms, how large are they compared to the expense of attending in specific drug categories, and on average, etc., etc.

That would be an interesting little project.

Unsubscribe screen shot composite from WebMD “Professional”

Can Hookworm Cause Anaemia in Therapeutic Numbers?

I have asked each of the PhDs who work for Autoimmune Therapies to write articles and reviews of scientific papers on the subject of helminthic therapy, the Hygiene Hypothesis and Old Friends Hypothesis, etc.

I have done this because so much of what is discussed online regarding helminthic therapy is uninformed or based on folk-knowledge, much of it being flat wrong.

Of course a great deal of the research and what is known is very difficult to find, and even harder to understand.

I and those of us who work at Autoimmune Therapies have been studying the subject for years.

I have been reading about the life-cycle of hookworms and whipworms, the Hygiene Hypothesis, and Old Friends Hypothesis, as well as the impact of infection with either hookworm or whipworm on the human immune system, since June, 2004. That was when I first encountered the concept of the Hygiene Hypothesis and the work of Dr. David Pritchard, and others, thanks to my aunt.

One of the most misunderstood aspects of hookworm is their potential to cause anaemia. I have read on someone’s blog for instance that a single hookworm can take up to six pints of blood per day. The person writing the post apparently is not aware that we each have roughly only 8 pints of blood. Or that an adult hookworm is only about one centimetre long and a half a millimetre wide. It is hard to imagine how so much blood could be consumed by such a small organism.

But how much blood does a single hookworm consume in a day?

That depends on which species of hookworm we are talking about. Here we are discussing Necator americanus, the kind that Autoimmune Therapies uses. We selected N. americanus instead of Ancylostoma duodenale because N. americanus draws much less blood, and lives far, far longer than A. duodenale.

According the various parasitology texts and papers I have read that examine this subject the most commonly quoted figure is 0.01ml/day per adult hookworm. Which works out to be 0.3ml/month, if the month has 30 days.

To put that amount in perspective a teaspoon contains about 5.0ml of liquid if filled to the top.

The second most commonly quoted figure for daily blood loss per adult hookworm is 0.03ml per day. Which gives a monthly amount, for a thirty day month, of 0.9ml/month.

The respective amount of blood lost to an infection with 50 hookworm each 30 days then must be between 15ml – 45ml.

In comparison the range quoted on Wikipedia for blood lost each month to menstruation is 10ml – 80ml being considered normal, and 35ml/month considered average.

So clearly, unless you have some disease that leads to blood loss or can cause anaemia, a therapeutic number of hookworm do not represent any risk of anaemia, because clearly the body can cope with a monthly blood loss of at least 100ml without problems.

But how much blood loss per month can humans tolerate, after all a menstruating woman with hookworm might be a risk of anaemia.

Marc wrote the following discussion of the body’s ability to replace lost blood in reply to a thread on the Yahoo Forum on this subject. If you are interested the thread is here.

“Just a note on blood loss, depending on the source the upper limit of average blood loss due to menstruation is 80-100 ml per month. Assuming the highest level of blood loss per worm is 0.03 mL/day which is the most commonly reported higher amount for N. americanus, this equates to 63 ml/month for 70 hookworms (note that AIT provides 35 hookworm as the most common therapeutic dose, although up to 100 will be provided if necessary).

To put this into context, a woman donating blood will give (in the UK) 470 ml of blood per donation without any adverse consequence. The average adult can lose up to 15% (approximately 800 mL) of their blood suddenly without clinical symptoms. So even if we assume 126 mL of blood loss per month to hookworm, double the known amount taken by hookworm, the body is easily of capable of replacing this.

To demonstrate the ability of the body to cope with chronic blood loss, the following calculation may be useful, I have used a blood loss that is double the maximum expected from 70 hookworm which allows for extra blood loss as they move around, at the same time I have assumed the lowest values pertaining to our bodies’ ability to produce Red Blood Cells (RBC).

Therefore, in reality the following calculation underestimates the ability of the human body to replace blood loss from helminths by somewhere between 2 and 5 fold.

We like to be conservative at AIT.

The use of RBC is more appropriate than the use of the total blood volume when evaluating the impact of hookworm on the body’s iron status. It is the RBC that transport oxygen, and it is a decrease in RBC or in haemoglobin in the RBC, that is by definition anaemia. Total blood volume is independent of RBC, and maintained at a fairly constant level at the expense of all other factors.

Assuming there is no reason why normal red blood cell (RBC) production can not be achieved (such as dietary iron deficiency, the normal RBC production in an average male is 18 ml/day. The body can increase production of RBCs by up to six times this value when needed. The average adult male has a haematocrit of 48% (that is each litre, 1,000ml, of blood contains 480 mL of RBC, i.e. 48%). Assuming 126 ml per month of whole blood loss due to hookworm(0.03x70x30x2), this equates to the loss of 60 ml of RBC per month (126×48%).

the human body in that same time produces 540 mL (18×30) of RBC, and can if required produce at least 3240 mL of RBC per month (540×6). Therefore using this worst case scenario, there is an approximate 54 fold excess in the volume of RBC’s that can be produced by the body (3240/60) compared to the amount that are lost to hookworm. For women the calculation is slightly different as the average haematocrit  and the production of RBC per day will be slightly different.

This means that unless there is a significant factor already causing iron deficiency, such as poor dietary intake (malnutrition), or poor absorption of iron, due to dysfunction of the small intestine (or surgical removal as is common with Crohn’s Disease), hookworm on their own in appropriate therapeutic numbers, like those provided by AIT, cannot cause iron deficiency and subsequent anaemia.

Bottom line: There is no risk of developing anaemia if you are provided hookworms by AIT, or know what you are doing and use the appropriate number of hookworm

For the record, I infected myself with a total of 300 N.Americanus and show no signs of anaemia about six months later.

Jasper Lawrence

Can Hookworm Cause Anaemia in Therapeutic Numbers?

I have asked each of the PhDs who work for Autoimmune Therapies to write articles and reviews of scientific papers on the subject of helminthic therapy, the Hygiene Hypothesis and Old Friends Hypothesis, etc.

I have done this because so much of what is discussed online regarding helminthic therapy is uninformed or based on folk-knowledge, much of it being flat wrong.

Of course a great deal of the research and what is known is very difficult to find, and even harder to understand.

I and those of us who work at Autoimmune Therapies have been studying the subject for years.

I have been reading about the life-cycle of hookworms and whipworms, the Hygiene Hypothesis, and Old Friends Hypothesis, as well as the impact of infection with either hookworm or whipworm on the human immune system, since June, 2004. That was when I first encountered the concept of the Hygiene Hypothesis and the work of Dr. David Pritchard, and others, thanks to my aunt.

One of the most misunderstood aspects of hookworm is their potential to cause anaemia. I have read on someone’s blog for instance that a single hookworm can take up to six pints of blood per day. The person writing the post apparently is not aware that we each have roughly only 8 pints of blood. Or that an adult hookworm is only about one centimetre long and a half a millimetre wide. It is hard to imagine how so much blood could be consumed by such a small organism.

But how much blood does a single hookworm consume in a day?

That depends on which species of hookworm we are talking about. Here we are discussing Necator americanus, the kind that Autoimmune Therapies uses. We selected N. americanus instead of Ancylostoma duodenale because N. americanus draws much less blood, and lives far, far longer than A. duodenale.

According the various parasitology texts and papers I have read that examine this subject the most commonly quoted figure is 0.01ml/day per adult hookworm. Which works out to be 0.3ml/month, if the month has 30 days.

To put that amount in perspective a teaspoon contains about 5.0ml of liquid if filled to the top.

The second most commonly quoted figure for daily blood loss per adult hookworm is 0.03ml per day. Which gives a monthly amount, for a thirty day month, of 0.9ml/month.

The respective amount of blood lost to an infection with 50 hookworm each 30 days then must be between 15ml – 45ml.

In comparison the range quoted on Wikipedia for blood lost each month to menstruation is 10ml – 80ml being considered normal, and 35ml/month considered average.

So clearly, unless you have some disease that leads to blood loss or can cause anaemia, a therapeutic number of hookworm do not represent any risk of anaemia, because clearly the body can cope with a monthly blood loss of at least 100ml without problems.

But how much blood loss per month can humans tolerate, after all a menstruating woman with hookworm might be a risk of anaemia.

Marc wrote the following discussion of the body’s ability to replace lost blood in reply to a thread on the Yahoo Forum on this subject. If you are interested the thread is here.

“Just a note on blood loss, depending on the source the upper limit of average blood loss due to menstruation is 80-100 ml per month. Assuming the highest level of blood loss per worm is 0.03 mL/day which is the most commonly reported higher amount for N. americanus, this equates to 63 ml/month for 70 hookworms (note that AIT provides 35 hookworm as the most common therapeutic dose, although up to 100 will be provided if necessary).

To put this into context, a woman donating blood will give (in the UK) 470 ml of blood per donation without any adverse consequence. The average adult can lose up to 15% (approximately 800 mL) of their blood suddenly without clinical symptoms. So even if we assume 126 mL of blood loss per month to hookworm, double the known amount taken by hookworm, the body is easily of capable of replacing this.

To demonstrate the ability of the body to cope with chronic blood loss, the following calculation may be useful, I have used a blood loss that is double the maximum expected from 70 hookworm which allows for extra blood loss as they move around, at the same time I have assumed the lowest values pertaining to our bodies’ ability to produce Red Blood Cells (RBC).

Therefore, in reality the following calculation underestimates the ability of the human body to replace blood loss from helminths by somewhere between 2 and 5 fold.

We like to be conservative at AIT.

The use of RBC is more appropriate than the use of the total blood volume when evaluating the impact of hookworm on the body’s iron status. It is the RBC that transport oxygen, and it is a decrease in RBC or in haemoglobin in the RBC, that is by definition anaemia. Total blood volume is independent of RBC, and maintained at a fairly constant level at the expense of all other factors.

Assuming there is no reason why normal red blood cell (RBC) production can not be achieved (such as dietary iron deficiency, the normal RBC production in an average male is 18 ml/day. The body can increase production of RBCs by up to six times this value when needed. The average adult male has a haematocrit of 48% (that is each litre, 1,000ml, of blood contains 480 mL of RBC, i.e. 48%). Assuming 126 ml per month of whole blood loss due to hookworm(0.03x70x30x2), this equates to the loss of 60 ml of RBC per month (126×48%).

the human body in that same time produces 540 mL (18×30) of RBC, and can if required produce at least 3240 mL of RBC per month (540×6). Therefore using this worst case scenario, there is an approximate 54 fold excess in the volume of RBC’s that can be produced by the body (3240/60) compared to the amount that are lost to hookworm. For women the calculation is slightly different as the average haematocrit  and the production of RBC per day will be slightly different.

This means that unless there is a significant factor already causing iron deficiency, such as poor dietary intake (malnutrition), or poor absorption of iron, due to dysfunction of the small intestine (or surgical removal as is common with Crohn’s Disease), hookworm on their own in appropriate therapeutic numbers, like those provided by AIT, cannot cause iron deficiency and subsequent anaemia.

Bottom line: There is no risk of developing anaemia if you are provided hookworms by AIT, or know what you are doing and use the appropriate number of hookworm

For the record, I infected myself with a total of 300 N.Americanus and show no signs of anaemia about six months later.

Jasper Lawrence

Update on “A” and her progress

More good news on the progress of “A”.

For those of you who have not read “A’s” story, about how her severe Crohn’s has responded to helminthic therapy, you can read two earlier accounts of her progress since starting helminthic therapy for Crohn’s Disease (whipworm, her disease is active in her colon) about eight months ago here and here. “A” was about 2 years old when she started on therapy, 14 months when diagnosed.

This latest from her father:

Start Quote:

First recent email:
I thought I’d write you on a few things, as the good news on “A” has gotten better. First, we got the shipment (whipworm – Jasper), and everything went well. I realize I have yet to pay for it, but I will fax the credit card information to you early next week. I apologize for the delay. The second thing is that “A’s” GI got the biopsy slides back from her recent colonoscopy and the results were fantastic. They showed only mild inflammation, and no granulomas. Her previous slides from last years colonoscopy had shown bad inflammation, and granulomas everywhere. Her doctor said particularly the granulomas disappearing was “amazing”. I’d like to know to what extent of amazing the disappearing granulomas are, but I can’t find much information on granulomas as it relates to Crohn’s. But none-the-less it is obviously a great thing, and further reinforces the effects of the therapy. I also mentioned to her that you would be interested in talking with her, and she said that was fine. I’ll give you her information again, Dr. Name and contact information redacted – Jasper.

So good luck. She seems very excited about “A”, as are we.
On another note, I found a group on parents of children with IBD on the web. I read some of their stuff, and felt a particular kinship with both them and their kids. Needless to say, much of the subject matter is not pleasant. I was struck by the fact that their experiences could be an alternative for ours, had we not been so fortunate. I plan on posting a little thing about our experience with helminths. Perhaps someone could be moved by the irrefutable facts of “A’s” success. I’m not at all sure of the response I’ll get, if any, but if you don’t mind, and someone is interested, I could pass your information on to them.

Second recent email:

Jasper,

It’s good to hear from you again. You may post what you would like on your blogs, we trust in your discretion. Another good thing on “A”, is that since she got the second dose she has gotten even better. Her stools have been almost completely formed for weeks now, and we have seen absolutely no blood. This is certainly her longest run yet.
We will continue to stay in touch, hopefully with only good news! Thanks again to you and everyone else involved.

End Quote.

Fantastic, isn’t it?

Jasper

Part 3: Update on “A” and her progress

This is, as the title suggests, one in a series of posts, almost entirely derived from emails from her family that they send me periodically to keep us up-to-date.

At the end of this post, and in a few minutes all the others, is a standard block of text with links to each part of the story of this child, as well as some additional information.

———–

More good news on the progress of “A”.

This latest from her father:

I thought I’d write you on a few things, as the good news on “A” has gotten better. First, we got the shipment (whipworm – Jasper), and everything went well. I realize I have yet to pay for it, but I will fax the credit card information to you early next week. I apologize for the delay. The second thing is that “A’s” GI got the biopsy slides back from her recent colonoscopy and the results were fantastic. They showed only mild inflammation, and no granulomas. Her previous slides from last years colonoscopy had shown bad inflammation, and granulomas everywhere. Her doctor said particularly the granulomas disappearing was “amazing”. I’d like to know to what extent of amazing the disappearing granulomas are, but I can’t find much information on granulomas as it relates to Crohn’s. But none-the-less it is obviously a great thing, and further reinforces the effects of the therapy. I also mentioned to her that you would be interested in talking with her, and she said that was fine. I’ll give you her information again, Dr. Name and contact information redacted – Jasper.

So good luck. She seems very excited about “A”, as are we.

On another note, I found a group on parents of children with IBD on the web. I read some of their stuff, and felt a particular kinship with both them and their kids. Needless to say, much of the subject matter is not pleasant. I was struck by the fact that their experiences could be an alternative for ours, had we not been so fortunate. I plan on posting a little thing about our experience with helminths. Perhaps someone could be moved by the irrefutable facts of “A’s” success. I’m not at all sure of the response I’ll get, if any, but if you don’t mind, and someone is interested, I could pass your information on to them.

Second recent email:

Jasper,

It’s good to hear from you again. You may post what you would like on your blogs, we trust in your discretion. Another good thing on “A”, is that since she got the second dose she has gotten even better. Her stools have been almost completely formed for weeks now, and we have seen absolutely no blood. This is certainly her longest run yet.

We will continue to stay in touch, hopefully with only good news! Thanks again to you and everyone else involved.

End Quote.

Fantastic, isn’t it?

Links to rest of series on “A”

“A” was under 2 years old when diagnosed with Crohn’s Colitis, and the disease appears from the family’s descriptions to have been severe and aggressive. They approached us when the recommendation for treatment from the child’s Gastroenterologist was one of the biologics, either Remicade or Humira, I cannot remember which.

Below are links to each of the four posts, so far, which for the most part are just emails from the child’s dad on “A’s” progress, and his thoughts and observations.

Managing the links between the posts has become cumbersome, so I have created this standard block of links to tie the story together, explain the context if someone happens upon one of the posts and does not realise they are part of a series, and will probably make a static page to aggregate the whole thing.

Part 1: Part 1 of the story of “A”

Part 2: Part 2 of the story of “A”

Part 3: Part 3 of the story of “A”

Part 4: Part 4 of the story of “A”

Why McMaster ova counts are largely worthless for detecting changes in helminth population

The Argument Against Egg Counts as an Indicator of Helminth Number

  • Parasitology texts note that per day female hookworm and whipworm ova production varies from 2,000 to 20,000 total. For this reason alone any estimate based on an ova count must have a variance of x10. That is the answer can only be expressed as a range, with the higher end of the range being ten times the low end. So a typical answer would be “from 20-200 hookworm”. Fairly useless, particularly if you are trying to detect the loss of one or two hookworm. On this basis alone the test is too crude for the purposes most with deliberate helminth infections are trying to use it for.
  • Egg counts are a measure of density. So any count is going to be affected by things like the speed of material through the intestines (constipation or diarrhoea at the extremes), amount eaten, amount of fluid drunk, fibre content of food, etc. If you think of the extremes one can see this is going to have an enormous impact on density of ova per gram of faeces. Different foods and drugs affect the speed of material through the intestines.
  • Any count depends on extreme precision and replication of methods and precision from test-to-test. Only an experienced lab technician is capable of accurately counting ova in stool, stains are no aid and identifying each and every ova in a gram of faeces is difficult work. In someone producing 100 ova per gram .1 grams will contain 10 ova, so the slightest variation in weight can have a big effect on the number observed, that effect then being amplified by the multipliers used to derive worm population from egg counts.
    Ova production varies tremendously with time. Hookworm ova production falls by an estimated 50% about one year after infection. But there is little information on whether this is invariably 50% or exactly when it happens or how fast.
  • Ova production in all helminths is affected by various drugs, some known, some inevitably unstudied. So, antibiotic use so profoundly reduces ova production that parasitology texts recommend not doing ova tests for two weeks after the subject stops taking the antibiotics. Other drugs almost certainly have various effects as well.
  • McMaster egg counts have been abandoned by doctors of veterinary medicine as being useless as a practical tool for estimating worm numbers. They would know.
  • Most people using helminthic therapy, if using N. americanus or T. trichiura, know how many helminths they received. So the only purpose of ova counts is to monitor infection levels. But given all the other factors noted here the test is not sensitive enough to detect even a relatively large change in numbers.

    Egg counts can be used as a broad indicator of worm burden, but only as an indicator. McMaster egg counts were intended for use to determine whether someone has a heavy, moderate or light infection, so appropriate treatment (as in elimination except in light infections) could be prescribed.

    Researchers use egg density measurements in studies to monitor worm burden in their study subjects, but they have specialised equipment and the training to do so reliably and consistently. Even then they cannot indicate much, and beside most studies continue for far less than one year. So any change they are likely to detect would be gross, that is loss of worms. Which is undoubtedly what they are primarily looking for.

    The only method with any real utility to determine helminth population is endoscopy for hookworm and colonoscopy for whipworm.