Your Friendly Neighborhood Hookworms

- Hi, I'm Molly Webster, and this is Radio Lab.

- And what are we doing today, Molly? - Okay, well, Latte, remember back in 2009. Before you and I both worked at the show, there was an episode called Parasites. - Oh my God, love that episode.

- It is really one of my favorites, and in that episode, we talk about this tiny, maybe creepy little worm called the hookworm. - That's right. - Yeah, I mean, like, how you hooked into my brain,

like the-- - The hookworm we had to bring. - It's the story of that one guy, and then there's the final scene where he's walking through. - Oh, wait, okay, wait, wait, wait, you don't actually have something.

Don't say what the final scene is, is because what we're gonna do here is, I'm gonna play the hookworm's chunk of that episode. And then I have an update, a 20 year later hookworm in human medical,

- VH1 behind the music, where is the hookworm now?

“- Yes, where is the hookworm, and where is the human?”

- Okay, great.

This whole episode, it introduced this idea

that this thing that we think is like, the biggest, scariest, grossest pest of all time, maybe they're not as gross as you think. - Yeah. - And now 20 years later, people are saying,

maybe they're really not as gross as you think. - Love it. And there's just like all this cool new research about hookworms in the human body, and specifically one very important type of disease,

autoimmune disorders. - That, as you know, is one I'm particularly interested in. But, well, yeah, I'm, I'm salt, I would like to hear more. - Okay, great. So I'm gonna play the original hookworm segment,

just what we all know what's going on, and then we'll jump into an update in about 20 minutes. - Okay, great. - All right. - Okay.

- All right. (crying) - You're listening to Radio Lab. - Radio from, - From, - R-N-N. - W-N-Y-S. - Hey, hey, hey, hey.

- R-E-Y. - Hey, hey, hey, hey, hey, hey. (crying) - Hello, I'm Jada Bumran. - And I'm Robert Croix, this is Radio Lab, our topic today. - Parasite, - Parasites.

- Now we've met them there nice, and we've met them there not so nice. - I don't know that we've met any nice ones, really. - But we haven't, I thought, I thought that-- - Oh, they're all split, yeah, they're all pretty nice.

- Yeah, they were nice. - So, and now the question is, let's just talk about scale. I mean, for the most part, they're irritating and little, and they seem kind of invisible-- - Invisible and sort of off-stage.

- Yeah. - But when you back off a little bit, consider them, you know, in the effects that they have on the world.

- There are actually these powerful sculptors

of monumental narrative. - In other words, these are little guys telling very big stories. - In fact, here's an example. Recently, I went to visit a guy named Dixon, dyspomeye,

but Columbia University, he's a�ologist, and well, there's a bunch of things. We ended up talking about-- - Well, he told me this crazy story. - Okay, Molly jumping in here really quick.

This next part of the story, which has to do with Rockefeller, think of it like those stories that has been told so many times. It starts to become like a tall tale. It's a living myth, so the facts are a little blurry, but the idea is right.

Here we go. - The story I love telling the most, is how we eradicate a hook run. - The story begins in 1908. - John D. Rockefeller's senior.

- Really rich guy is sitting in his New York office. - And he's thinking--

“- How can I make more money selling something to the South?”

- Yeah, I've got all this money. Got all these resources. I just need a new market. And in terms of new markets to the South, it was pretty much untapped.

If only those damn southerners. - We're just getting off their butts and get going. - Problem was, they weren't. They weren't getting off their butts. - The firms were not operational.

The economic engine was turned off. - The economy was in the toilet. And so John D. Rockefeller wanted to know why. - Why aren't they producing more? - Yep.

- What's happened to their economic engine? - So he thought-- - I know, I'll form a commission. - Yeah. - So he said that in a bunch of economists and sociologists

and people like that on the original Rockefeller commission. They did everything a commission could possibly do to try to find out why these southern gentlemen were not rising to the occasion. And they came back with the following conclusion.

Well, we don't exactly know what's wrong, but we think that these people are sick from something 'cause they don't behave like we do. - What does that mean? - They are slow.

(laughs) Not mentally. They're slow physically. They're pale. - I'll give you an example.

Remember the movie deliverance? Sure.

“- Okay, remember that little guy that played the banjo?”

- I remember the other scene that we are. - Yeah, I can talk about that.

what that little banjo player looked like.

(bell dings)

“- Well, why are we looking guy, but he looked old?”

- Sickly pale. - Yeah, sickly pale, and yet an adult. Well, the leader said, wait, I was like, "That is not a description of all southernism." - No, no.

- No, I'm teeny cornering that. - Well, what I wanted to say about a lot of these southern people that they encounter, is that a lot of them, they just don't look right. They look weak, they look when, they look kind of,

when, one, one, one. - They were one. - Hale, lethargic. - It's interesting, when are one? - One, YouTube.

- So the thought was that maybe these southern has had some kind of laziness disease. This is really what a lot of folks thought. But one member on the committee suggested a rocker, like, you know what, perhaps these people are anemic.

- Anemic, they're anemic, do you say? - Yeah, they're anemic.

It sounds like a medical problem, then.

Maybe they're not lazy after all. Maybe they're anemic, and maybe they're just weak. - Next thing you know, rock filler puts together another commission to find out what the basis for the anemia was.

And not only did they find anemia,

“but they found a correlation of the anemia”

with soil types, that's bizarre. Sandy Lomi soils, anemia, hard-packed clay soils? Hmm, no anemia. Sandy Lomi soils, good farmland, hard-packed clay soils. Not such good farmland.

So all the rich farmers were anemic and all the poor farmers were doing okay. - And this seemed to be a clue. The incidence of anemia was linked somehow to the soil, maybe, but bum, bum.

- Yeah. - Something was in the soil. - That's correct. So somehow they hit upon this idea of looking for hookworm. (gentle piano music)

- The hookworm. - The hookworm. (gentle piano music) - So they thought, all right, let's run some tests. And when they did big time, they discovered hookworm,

big time. (gentle piano music) So the anemia is due to hookworm. - Now the question became, how are these southerners getting the hookworm

and giving it to one another? And a pretty good place to start to look for an answer was their feces. 'Cause if these hookworms are in you,

“they're gonna come out of you when you go to the bathroom.”

So they ask these southerners, "When you guys defecate, where do you do it?" Most of them said something like this. - I defecate over there. See that tree over there?

That's right, defecate. So I defecate over there, but I live over here. - Okay, so then the investigators ask the next question. "When you go to that tree and do it, do you wear any shoes?"

Most of them said, "No." - Barefoot, just like everybody else. 'Cause it's comfortable. (gentle piano music) - So clearly these worms are in the feces

that are landing near the tree. There's somehow getting into people's feet the next time they come to use the tree. But no one intentionally steps in their own, you know, no one does that.

- Which man? - Oh my goodness, oh my goodness, it can crawl. (gentle piano music) - Right, so let's find out how far it can crawl. - So what they did, these researchers,

as they built a sandbox, then they took some hookworm and fested stool and put it right in the middle. Then every day, we'll sample from the stool sample out in the sand in all directions

and find larvae and find out how far they can travel. How does that sound? So now we have larvae in the stool and they begin to crawl away from the stool, seeking a victim.

On day one, they crawl an entire foot in all directions, but they were at a two feet. On day two, my God, they're at two feet. At day three? - They went three feet, I kept leaves.

- They're crawling all the way. Day four, they crawl to four feet. - About day five. - I'm allowed to ask. - Okay. (laughs)

- And what about day five? - Five feet? - No. - No. - Four feet.

- That's it. (gentle piano music) - So how in the world could you deal with this problem when these worms can crawl, they can crawl four feet,

it doesn't matter where you're defecate, they're gonna crawl away from that and within a four foot radius of that stool sample, you're gonna get hookworm. Unless you do something radical,

that's never been done before.

- They devised a scheme for burying the stool sample into the ground, six feet deep. - 'Cause if the worms can only make it for feet, well then that's two feet past the point where they die.

- We call that the outhouse. (laughs) - And in fact, Rockefeller got us wish. The South did rise again. - That sounds too easy to meet though.

You're telling me that an understanding of hookworm which created the outhouse, removed the, quote, southern laziness disease and they did rise. - With it.

- And you bring that all back to the hookworm? - I do. - Really? - No, I bring it back to sanitation.

of other reasons why the South rose again.

“They are conditioning in highways and universities.”

- Right. - And stuff like that. - So the hookworm had some help, but what is clear is that when we is a country began to distance ourselves from our own excrement, to put it bluntly, when we stop walking around

in our own (beep) there were all of these unintended consequence. - So I'm gonna let it disappear. He is the little good to disappear. She got a disappeared, Colorado disappeared.

She already had disappeared, crept us for him. Anything that's associated with parasites and feces disappeared. Every time we build out houses, and people use them religiously.

Guess what? Their kids could stay in school or they could learn more. They got a head faster. (upbeat music) (upbeat music)

- Dixin's Islamia is a professor of public health

and environmental health sciences and microbiology at Columbia University. - Can they make longer titles at that university? - He literally wrote the book on parasites. - The book is called Parasitic Diseases.

You know it very well. It's assumed to be a major motion picture. And now it's fourth edition. - In its fourth edition. - And while we're on the subject of hookworms

and the glorious campaign to deworm America, because this has been a very carefully crafted and intentionally fair program, you have heard the case against hookworms now. Let's turn the coin and say something nice

about hookworms and to begin that discussion, let's go to our reporter Patrick Walters. So how are you there? - Yeah, I'm here, Robert.

- So tell us a little bit about this fellow.

What's his name exactly? - The name is Jasper Lawrence. - That's right, Jasper Lawrence. - So where's he from? He actually grew up in England.

He grew up in this little farm in the southwest corner of England.

“And it's important to know, I think before hearing”

any part of his story that Jasper has had allergies for pretty much his whole life. - On really bad days, my eyes would swell up so much from pollen or everyone allergens that they would feel like they were swelling shut.

I could feel my eyes squeaking in my sockets. It was enormously uncomfortable feeling. - But it was nothing debilitating. - They were just allergies. - You know, he's just like most other people of allergies,

just learning to deal with it. - You know, you live with it. - But what changed for me in my late 20s, early 30s, was my asthma. And at that time I was living in Santa Cruz.

I was relatively recently married. We had three cats that had been grandfathered in with the relationship. And I started landscaping business. I really didn't want to work for someone else.

- I think someone with allergies starting a landscaping business, that seems kind of unexpected. - On a stupid is actually the word for it. And within six months or a year,

he starts to notice it's really weird barking cough.

“- Was there anything particular that brought this on?”

- No, it was just sitting and breathing. Cat certainly didn't help. - Right. - And during that period, my asthma got much worse very, very quickly.

By the time it was 1996, 1997, I was seeing specialists having skin allergen tests and cycling through emergency inhalers, trying singular and all these other drugs that were coming on the market.

I was being hospitalized at least a couple of times a year. - I mean, I looked terrible. I had dark eyes and pale waxy skin. I had that allergic look. It was a really bad time.

- And he decides in that summer of 2004 to take a vacation. - He made this visit to England. - Yeah, I took my two daughters back to see my aunt who would raise me very early in the visit. I was sitting at her kitchen table

and she asked me if I'd seen BBC documentary about parasites in their connection with things like asthma and allergies, multiple sclerosis. And of course I hadn't, but I went upstairs and go on the internet after lunch.

And I stayed on the internet until perhaps two in the morning. (upbeat music) I didn't install. - And he's reading and reading and the work of all these research.

One study after the next. - Japan and epidemiological studies in Africa and animal models and multiple sclerosis. This enormous weight of evidence that in the developing world, people don't really have asthma

or allergies. And what he discovers is that behind all of this to his shock is hookworms. Hookworm? - Yeah, hookworms.

- Yeah, I learned that asthma was 50% less likely and someone who had a hookworm infection. - So this sort of just hits you. - Oh yeah. - What did you think when you read that?

to obtain hookworm immediately.

I couldn't wait.

“- So hookworms are these very tiny worms,”

the size of a little hair. But if you take a microscope and use the zoom way in, they have this big circular mouth brimming full of pointy teeth. Very scary to look at. They have these toothy mouths so that they can

burrow up through your feet, ride through your blood and eventually end up getting your gut and start chewing on the inside of your intestine. - This guy wants hookworms in his intestines? - Absolutely.

- And so you had to just Google it? - Yeah, hookworms for sale. I mean, you know, someone's got to be selling them, but not nothing.

- I contacted every laboratory supply company

in the world in parasitology, research centers, and they all said the same thing. No various flavors of no. And so I came to the conclusion

“that I was gonna have to go to the tropics.”

- So fast forward a little. Jasper is in Cameroon along the coast, slightly literally and figuratively the armpit of Africa. - He's 200 miles north of the equator. It's extremely hot.

He finds a guy to drive him around. So he and his driver would go to a village. - He's got out of the car. - Walk up to these villagers and ask them if they could see the little train.

- Just an open area of ground. Usually with bushes, so people can have a little bit privacy. And I would go over to the area, remove my shoes, and start walking.

The first time I did that, I almost couldn't do it.

It must have been 110 degrees that day. 100% humidity and the stench and the noise from the insects. It was so repulsive and so disgusting. - How many villages of the train, do you think you visited?

- Between 30 and 40. Jasper spent two weeks there walking around and village the trains and many full home. - I got back from Africa in early February. So I was looking at allergies season coming up.

And the day I realized that I had no longer had allergies, I had was such a good day. I got into my car and I started driving and I had the window down. I felt the breeze blowing across my face.

In the past, what that meant was that very quickly, my eyes would be itching uncontrollably. Snot and flam was gonna be pouring out of every office in my face and it didn't happen. It didn't happen.

I just started screaming in the car. I was so, so happy. And I haven't had an asthma attacks since I went to Africa. - I know longer had allergies.

The vast majority of the benefit of life, I've experienced just come from hookworm. - What is the hookworm doing? Do you know? - Well, so the immune system that we learn about

in elementary school is all about like these attacks cells that go after foreign invaders and destroy them.

“And that's a big important part of the immune system,”

but if the immune system were allowed to attack and destroy things, unchecked. I could kill you. And there are lots of diseases where the primary symptoms are caused

by the immune system attacking the body that it's really designed to protect. Allegies and asthma are just two of these. Some of the more serious ones are like type one diabetes, multiple sclerosis, crones disease,

in which the immune system actually starts attacking the inside of the intestines. They're like 80 of these diseases, 80 of them. And so what scientists have found in lots and lots of mouse studies, and in some human studies

to this point too, is that once the hookworms get inside the gut, and the immune system actually starts attacking somehow, hookworms actually stimulate these cells, which is quite things down. And tell the attack cells to stop attacking.

So these are like lolliby cells? - Exactly. - What lots and lots of scientists think. - Which is what that's got, tough, smithical center. - And dozens of others,

is that over thousands and thousands of years of hookworms almost developed in tandem with the human immune system co-evolution. Paracites living within your body, your immune system changes. You got to a point where the hookworms could survive safely.

- Where him gets a home, there's food coming down the food pipe, and in return.

- Some form of the positive regulatory advantage.

- So that if you had this glitch

“where your immune system started attacking your own body,”

the presence of the hookworms would keep things controlled. - That's the gift. You do something for the worm, the worm does something for you. - So then, by that logic, what we in the West, in the richer countries have done stupidly,

is we have cleaned ourselves up too much, and we don't have enough worm-easiness. - Yeah, this is called-- - They call it the hygiene hypothesis. - The hygiene hypothesis, that we are not dirty enough.

- Too clean. - We function like rainforests, we're ecosystems, and we've entirely eliminated a class of organism that co-evolved with us and our genetic predecessors from millions of years.

- Now, I don't want to leave the impression that hygiene is bad for you. People can't go back to living in filth, kids playing in sewage by the riverbank, but in improving our hygiene.

We are also excluding organisms that may be important from making us well. - So then, what is Jen's Purdue about all this? - He decides to start a business, selling hookworm to people.

- What? - You can call him up, and he will literally FedEx a dose of hookworms to your door. - How?

- So I'm breaking for a second.

- Fat. - Hi, Jen. Where does he get the hookworm from? - This is weird. Jasper gets the hookworm from himself.

- Could you describe how you go about getting hookworm from your stool into one of your patients? - Well, that's very easy organism to work with. It just gets up and it walks out of it.

So it doesn't take an enormous amount of work to separate it from the feces. And then I haven't done that. I repeatedly wash them in solutions of antibiotics

“to make sure that I think the could live on them”

is killed. People contact us, we'll have them complete a questionnaire, submit a recent blood test, then we'll ship them a dose and all the materials and equipment and the instructions

and a surgery to infect themselves.

- To me, is this a safe thing to do?

Jasper, Jasper has done tons and tons of research, but he's not a doctor. - Right. - The treatment is not approved by the FDA. - I wonder, is there any serious sort of double blind study

trying to figure out whether some safe delivery of hookworm might make sense? - Yeah, so one of the guys who was sort of a pioneer in this hookworm research is David Pritchard. - I'm Professor David Pritchard,

the deanologist and parasitologist at the University of Nottingham where I study parasites and the wound healing properties of maggots. - So we've now got two safety trials and drought belts, but we've yet to conduct the trials

to show the therapeutic benefit results from infection with worms. - So Pritchard infected himself, pretty much just to make sure that it was safe. - What we did was tell of us in the lab took worms

at different doses. We were either given 10, 25, 50, or 100 worms and then we had to report on the symptoms. And on the back of that study, we determined the 10 worms were tolerated.

- But Pritchard, when he did this proof of safety study, actually gave himself 50 hookworms. - Oh. - Which put him out of commission for a while. - Well, I felt pretty bad, I mean,

pain in the gut really, you know, you could feel them 'cause they are biting on your tissues. - I mean, if you have too many hookworms, they can cause things like diarrhea and the most serious side effect in the side effect

that makes them sort of a public health enemy is that they can give you anemia. - So if you have too many, you lose quite a bit of blood to these parasites. - Well, you know, if you take too many hookworms,

which are not gonna have you come to us,

“the worst thing you're gonna get is anemia,”

but it's not like you wake up one morning and you're drained of blood. Very slow to develop and it's very easy to deal with. - Desperate's kind of just gone for it. - Yeah, it's a very sort of like cowboy move.

- So the scientific community, I think, they believe that I'm premature enough. - It's not FDA approved. - And offering this to the public. - You don't know what it is, you don't know what's purity,

it's not safe. - But I've talked to several clients who had really severe allergies and asthma. They say they've just achieved these great results. And Desperate also says you've seen success

with a few multiple sclerosis patients and several crimes to these patients too. - Like how many people do you think that you have infected? - That's about 85 right now.

- How is business? - There's nothing there. - Business is adequate, but I honestly don't know why. I don't wake up in the morning with my front garden, 20 deep with people with ulcerative colitis,

Crohn's disease allergies. I just don't know why I'm not completely buried. - The way he sees it, people are scared. - Well, there are the people who are coming from a point of view of what they learned in kindergarten

about clean drinking water and soars to them, worms and parasites are so repulsive that there's nothing good to be said about them. But I can make you better.

I mean, for God's sake, these organisms fall out my rear end every day.

I have a million at a time.

“The raw material is human experiment for God's sake.”

All people have to do is open their minds. Are you really that scared of a little worm? (gentle music) - Okay, okay, okay, okay, okay, okay, okay, okay, okay. - So, so, wait, but, okay.

- Yeah, maybe the question is, let's have talk about this on the show. You have an autoimmune disorder. - Yes. - Crohn's disease disease.

- Okay, you've heard this piece. Are you scared of a little worm? - I mean, I am intrigued, I don't know whether to be scared. If there are clinical trials that can help tell me whether to be scared or not of this worm,

that's what I want to know. - All right, well then, I am gonna tell you about a clinical trial, and then you can tell me what you think. - Okay, okay, okay, okay. - All right, oh, after the break, after the break.

- After the break, after the break, let's do it. - A clinical trial. - I'm ready, I'm excited. - Okay, great. - Hi, Lulu here, and this episode is sponsored by Better Help.

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but wherever it may be to help guide them through the rough patches of life, I just wanted to take a moment to say what seems to help people, turn corners, find relief, get out of rats, and even flourish is having someone with you.

As much as we can feel private about our mental health struggles, you do not have to go it alone.

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and start seeing how the economy really works. - Let's if we are back from break, and we left you at, are you scared of a little worm? - And I was like, maybe, maybe, I don't know. Let's do some actual clinical trials.

- And then is what, okay, so that episode was done in 2009. - Right. - And so I want to fast forward to today, they're have been a number of clinical trials. - He's a what happened.

- Okay, so hi. - Hey, how are you? - I talk to this researcher. - Dr. Paul Jackiman. - Paul Jackiman.

- Senior Research Fellow at the Australian Institute of Tropical Health and Medicine.

- And he's basically trying to do like the next iteration

of Jasper, of like Jasper, but like with actual scientific studies and stuff. - Okay, yeah, trying to understand the potential beneficial effects of worms in people. - So one of the things that he's been studying is

- Treating people who are at risk of type two diabetes with hook worms. - So type two diabetes. That's the diabetes you typically get later in life. - Yeah.

- What made you pick diabetes? - It sort of came on the back of research which started in the 2000s where people went into regions of the world where parasitic worms are really common. - And what they found is that there's a correlation

between something like type two diabetes and the presence or lack of worms. - Huh, yeah, so basically. - So what Paul and his team did is basically they took people who are at risk for type two diabetes

and they gave them hook worms. - How do they give it to them? How do they take them?

“Do you like slur bit down like a little piece of the getty?”

- No. - You know, people think they're going to enroll. They're going to have to swallow a worm or swallow a worm etc. - It's actually much worse, or I don't know.

It could be much better than that.

- Basically in order to do our research.

- The first step of the process is they have folks who work in their lab. - These work called worm farms. - Volunteers. - We've consented to have a small number of worms.

- Living inside of them. - Oh, wow. - Yes, exactly. Anyway, you can't culture them. You can't just get them and freeze them.

- Really? - Yeah, so based that's one of the limitations about working with these worms, you actually have to maintain a scent

- They're like hazard pay for that.

Like, do they get a bonus?

“- No, I think they're just very generous volunteers.”

Brave and dedicated volunteers. And so that if we want to do our research, we say, hey, generous volunteer. - Can you give me a sample of your stool? - Okay.

- Because what happens in these people, in the worm farms, is the hookworms inside of them will mate. - And they can produce the females and produce tens of thousands of eggs every day, which are released eventually in the poo.

- Huh. - And so they poop? - We get the poo sample. Add charcoal to it. - Which reduces the smell,

and then we spread it onto their petri dish. - They leave the petri dish and sort of like kind of a humid tropical environment. - Okay. - It sits there for a week.

- And over the course of that week. - These tiny, hookworm eggs start to hatch. And emerging from them are these... - Microscopic. - Teeny, tiny, baby worms.

- Fairly visible to the naked eye.

“- And very quickly, pollen is team hit them”

with like a strong disinfectant. - To clean them.

- And then we can basically look down the microscope.

We just won by one, pick the regularly worms. Put them into a little tube. - And then, what they do is they put the worms on a bandaid, essentially. - Uh-huh.

- And they take that bandaid and they put it on the skin of the patients that are enrolled in the clinical trial. - Well, but not even on a cut. Just anywhere on the skin.

- Just anywhere on the skin. - And then we sort of sit with them for about five minutes because participants start to get this tingling sensation. - Because what happens is, these baby worms on the bandaid start to release an enzyme.

- Which, a dried tissue. - Which basically melts your skin so that they can start to burn into your skin. And as they enter your skin, then your skin just...

Closes up behind them, the tunnel closes.

And then the worm makes their way down through your skin into... - The lymphatics. Your lymphatic system. So, if you think of the inside of your body

as a water part, as one does, the lymphatic system is like the lazy river. - Sure, yeah. - So these baby hook worms go through the skin cells, fall into this like little lymphatic river.

Then they float along through your lymph system. I kind of maybe picture them with, I don't know, cozies of non-alcoholic beer because they are babies on their little tube. - That's funny.

- Floating down stream. - Uh-huh. - They float along. And they get to what is known as your lymphatic duct, which is kind of right by your collarbone.

And once they get there, they get shot out of the lymph stream into your bloodstream. - And once they've gone into the blood that cruising around, I'm gonna water slide. - They go from your collarbone

towards the center of your chest where they catch this huge slide that sends them into your heart and then your heart, the shoots them out onto another big slide. That slide starts splitting and branching and splitting

and branching and as it does, the slide is getting smaller and smaller and smaller. - Into. - Yeah. - These little baby worms get stuck.

They get trapped inside a super tiny blood vessel - Because they're too big. - Yeah, they're too big for the blood vessel so they get stuck there. - And they're Jenny ends.

- But, Paul says. - That's they key. - To again release an enzyme that starts to melt away the walls of the blood vessel, just enough. They can read all their way through

and then pop out on the other side of this blood vessel and into your lungs. - And then what they do is they grow. - They crawl. - Up through the lung all the airways.

like a rock climber boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop boop

“Which point they will shoot down your esophagus into your stomach?”

Oh my god. And then why wouldn't you, oh, but it's like, why wouldn't you just feed it to people then? Well, why do this whole crazy thing? Well, because this whole process from skin to gut takes about two to three weeks. And during that process, the worm is maturing.

God. And so it's actually developing in such a way that it can survive in your stomach. I see. So it's like this is how it develops. Exactly.

So it's a really fascinating life cycle. They can survive the stomach acid. And then they sort of make their home and the upper, just be on the stomach there and they're upper small intestine. And once they're in the small intestine, they've got these sort of quite violent looking teeth.

And they very fairly delicately just sort of suck the blood.

And this is where something sort of amazing happens, which is for the next two weeks.

Your body's going to have this really intense reaction. Uh-huh. So where the worm is biting down on your intestinal wall, it's going to get inflamed. There's like an open sore where the worm is sucking.

And your body is going to freak out and try and flush the hookworm out. So you're going to have diarrhea, you're going to feel sick. And then it's all going to stop. You're going to feel fine. And Paul says this is most likely because right around this time, the hookworm has reached

full adulthood. And we've actually in some of our clinical trials, taking a camera and we've had a look in the gut at regions of the gut where the worm has been feeding. And you know, there's might be one little small red spot there where next to a worm.

“But everywhere else, I think there's this rapid healing.”

The worm might actually be releasing factors that promote, you know, wound healing for example. Really? Yeah, absolutely.

It's in their best interest to basically feed and heal the wounds in their environment.

So the really cool thing is that when this hookworm reaches adulthood and it's bit onto you and it's making this hole in your intestine, it can actually release a protein or maybe many proteins to heal the wound at the same time. So you're not left with this gaping wound in your stomach. And then it's also producing other proteins that are quieting the immune system.

Because your immune system could, it could just unlation anormous to, you know, attack on these worms. But obviously the worm does not want that, so it has these whole proteins that decrease that tells your immune system should be quiet. And you heard about this in our last episode.

And I think this is what Jasper also sort of suspected was happening. There was something overall from the hookworms, quieting the immune system. I feel like you kind of reframed this whole thing for me, so now it's become less like a story of a human clinical trial and more of a story of like mission impossible on a worm scale. Like I'm like, how can this thing like, vault over this?

But then see the right words to this person that's a leave them alone. And then climb up there and then it's like it's crazy. And then use their little blaster to like melt this thing so that they can walk through this wall. It's like crazy. It's like a crazy thing that they're doing.

“But here's the thing, Latif, when Paul and his team got to the end of this two-year”

trial with people who were at risk for type 2 diabetes. The people who were treated with the hookworms had things like reduced like glucose levels and they had dramatically reduced insulin resistance levels, lost a little bit of weight. And some of these people who were considered pre-diabetic were no longer pre-diabetic. Oh wow, so some people were of cure effectively.

Yeah, basically. While when you look at the placebo people who got no worms, they went on to continue having high insulin resistance, glucose, no weight loss.

So it was really the first causal clinical evidence that the worms were having a benefit

on metabolic health. Then at the end of the trial, the end of the two years, the people who have the hookworms inside of them, they have the option to just get rid of the worms like you can take in over the counter deworming medication and they'll be gone the next day. Yeah.

Paul says at the end of this two-year study, almost everyone kept their worms. Wow. They were happy at the end, they wanted to be basically live with their worms. They were happy with them. And this is universal, every clinical trial, almost universally, at the end of a clinical trial,

people are happy with their worms. Do you think the happiness is emotional or do you think the happiness is like they actually feel different? Yeah, exactly. So there's two things.

One of them they might think, well, it's not doing them any harm. So let's just keep them. The other thing is we've, you know, in that two-most recent clinical trials, which were placebo controlled. So these trials were looking at celiacs disease.

Yeah, we asked people to do a quality of life and mood and well-being survey. And in both clinical trials, we had this really interesting improvement in well-being and mood and sleeping quality. We saw in the people with the worm treatment and the placebo as we didn't see it. I kind of explained it, but the data was there and it's really compelling.

And there is like weird thing, right?

“I know, so here's the thing, I'm going to break that down for you, which is like,”

one of the things we're all talking about right now is our microbiome. Right. It's like, what is the tiny stuff living inside of us like viruses and bacteria that's actually helping us? Right. One of the things Paul's talking about is like, well, there's also a microbiome.

You know, the microbiome, the organisms that you can see with your naked eye, these worms, that can somehow live for up to a decade or even longer within our gut. Their immune system should really have recognized these worms and kicked them out because there's

But Paul says it could be that when these worms, when they reached adulthood in your gut,

“when they start making the proteins that quiet your immune system,”

that actually suppresses the immune system. So the immune system doesn't kill it. Yeah. And that also means that then the immune system is like not reacting as strongly to some other things. So this is where the whole autoimmune thing gets into play because in autoimmune diseases, as you know, your own immune system is attacking you.

Right. And if you've got a worm inside of you telling the immune system, like, hey, you can chill out. I'm kind of part of you, like, don't attack me. Yeah, yeah, yeah, yes. They overall, it's just the immune system's not going to attack you.

I just, you know, this is the thing that's really confusing to me is why we've left you more confused. No, because like, why would, like, this is something that we need seemingly to regulate our own kind of internal army, right, like it's like, why would we

outsource this very crucial part of ourselves, like, like, you mean outsource, like outsource,

like the worms are not us, like, like, if they're, if they're helping regulate, we would, we would outsource it because they, because they're helping, like, we would outsource it,

“because it's beneficial. Like you have to imagine, like, we've been living with worms”

for millions of years. Yeah. And so a worm got inside of us and we probably killed it. And then a worm got inside of us and it probably killed us. Right. And then a worm got inside of us and it lasted a little longer. Yeah. And then we did or did not die. And it's, like, basically, this long term dance between us and the worm. So there's this really interesting truth that's happened throughout evolution, where the worm benefits and the host benefits.

The worm benefits because it's getting a place to live and some juicy blood to eat for years. And then the host, us benefits by not getting sick and dying, but also it's from the potential immune shaping and metabolic shaping powers of the worm. So Paul's lab has shown that people who are given hookworms have fewer symptoms associated with type 2 diabetes, celiacs disease. There's also other studies looking for benefits for people with multiple sclerosis,

ulcerative colitis. That's where you get ulcers in your intestines, crones disease, lative. Uh-huh. And in those studies, some people have gone into remission with worms. That's not Paul's lab, but that's other labs. Yeah. And, you know, if they're beneficial and, you know, why not turn into a treatment? But that's kind of the thing, which is that since 2009, when we did that Jasper story, even though there are all these studies showing that hookworms are beneficial,

hookworms are still not used as a medication or as a treatment. Yes, there's a lot of hurdles for developing hookworms as a medicinal treatment. Everyone is kind of like, listen, there's so many reasons why people don't want worms. Like, they're kind of just gross. But also, I briefly mentioned before, you get the larvae out of people's poo. So it's making a medicinal product with standardization

and decontamination. It's just really hard. Exactly. So at this stage, it's probably never

going to be a mainstream treatment. In fact, Jasper, who he had mentioned, was selling worms, he and his wife actually fled the U.S. because they were being investigated by the FDA. Wow. And so as an answer to this kind of problem of the live worm, what we're seeing is people like Paul, his team, other researchers, they're trying to develop the proteins, hookworms produced to heal your gut or quite your immune system. They're trying to take those proteins, make them in a lab,

and then put them in a pill form. But no one knows what the time table for that is. And so for now, you really are just stuck with having to get a hookworm. And there are some sort of more black market where people are actually selling them and you can buy them. But I wouldn't necessarily recommend that for people, partially for the reason because you're paying money for something, which it hasn't really been rigorously attested and it hasn't gone through the regulatory

processes that other medications need to go through. And so yeah, that's where that's where it's at.

“Okay, but okay, I got a goal, but my last question is Molly, should I get a worm?”

I mean, dude, if I was you and I was in pain, I would try and figure out how to get a worm or get into a clinical trial, can you fly to Australia, get into one of Paul's? I think that. I'll tell you the areas that they're doing it in. The big research areas are like the Netherlands,

just those lucky people over there that get worms, you know? Well, you know, you could always do a

“Jasper did, which is just go walk around and some poop and pick up, you know, hookworms, plus roundworms,”

plots, tapeworms, you know, that's an option. No, that's not, I'm not going to, I'm not going to roll in a human species. That was a level of desperate, you're not at? That's not how desperate I am.

Okay, well, Australia is then. Okay, hitting stop. Okay, hitting, hitting stop.

Okay. Thank you Molly Webster for the update. Your welcome update was produced by Matt Kilti, with help from Rebecca Rand. It was edited by Ariann Wack and fact checked by Diane Kelly. And we want to thank Pat Walters, Jack Abumrod, Robert Cole Witch, and the whole 2009

“parasite team that put that episode together. If you want to listen to the entire parasite episode,”

you can go check it out on our website. And for everything else, Radiolabby, please subscribe to our

totally FDA approved newsletter. All right, we'll be right back in 20 years. No, just next week. Yeah, we'll catch you next week. Bye. Hi, I'm Gabby. I'm from the Bay Area California, and here are the staff credits. Radiolab is hosted by Lulu Miller and Latif Nasser. Soren Wheeler is our executive

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