I have had severe allergies all of my life. As a child I had hay fever so bad that my eyes would swell shut and mucus would stream from my nose. I would lie in a darkened room with a cold damp flannel over my face to quell the itching, almost inebriate from antihistamines. Spring was pure misery.
Later I smoked cigarettes for seven years when I was a teenager and into my early twenties. I have been told that these two things are the prime markers for the development of adult onset asthma. That is exactly what I started to get when I reached my early thirties.
As my asthma got worse I became increasingly reliant on inhalers, pills and antihistamines as well as upon the oral steroid prednisone to stay out of hospital. I tried all the drugs and therapies available. As it was by the time I was in my late 30s I was a frequent visitor to the emergency room. As anyone who has experienced a severe asthma attack can tell you they are terrifying.
My use of prednisone increased, and as you may know the side affects of prednisone are quite horrible, particularly with long-term use. I started to suffer from some of these side affects, particularly obesity, and despite all this these drugs were only marginally effective in controlling my asthma.
Soon I was denied health insurance and so now I had the added burden of paying for all my medical care.
On a trip in the summer of 2004 to visit relatives in England I learned of a BBC documentary about the connection between a variety of intestinal parasites and various autoimmune diseases. Visiting the BBC web site (go here to view the BBC article or go here to see the many articles on the same subject indexed and available through google) I learned that not only did infestation with hookworm cure both hay fever and asthma but also Inflammatory Bowel Disease (IBD), Crohn's Disease and Colitis.
Wellcome Study into Asthma and Hookworm
ABC Science Online
- Asthma and Hookworm
Research at Nottingham - Asthma and Hookworm
Article about link between Asthma and Hookworm
New Scientist Article about Asthma and Hookworm
British Medical Journal on IBD & Crohn's treatment with hookworm
Crohn's & Ulcerative Coliltis research
Inflammatory Bowel Disease
Intrigued I did more research and located some peer reviewed scientific papers published in the Lancet and the New England Journal of Medicine that demonstrated this link (membership is required to view these articles). I roped in some friends with graduate degrees in hard sciences and asked their opinions. Once one sifted their replies to remove the institutional bias the consensus was that there seemed to be something there.
A google search regarding the University of Nottingham study conducted in Ethiopia, as well as recently undertaken study at Nottingham financed by Wellcome Laboratories indicates that hookworm does indeed cure asthma.
Obviously for the drug company that brings a new asthma therapy to market based on this research there is the potential for billions in revenue. Unfortunately even if they are successful in identifying the mystery compound the hookworm secrete it will take around ten years to bring it to market, assuming they are successful in proving efficacy and safety.
The Decision to Infest Myself With Hookworm
Based upon what I read, and what I learned about the hookworm I decided that I was going to try and infest myself with hookworm in an attempt to cure my asthma. I was not willing to wait ten or more years for the drug companies to bring a drug to market. It was obvious to me that hookworm, for a healthy adult with a good diet, are quite benign. This account details my experiences, how I went about it, and the things I have done since infestation to calibrate my level of infestation so that in the end I was able to cure my asthma and hay fever with hookworm. These same techniques are of course applicable to any hookworm infestation, whether you want to control asthma, hay fever, colitis, Crohn's disease or Inflammatory Bowel Disease (IBD).
All about the worm
Two species of hookworm commonly infest humans, Ancylostoma duodenale and Necator americanus. These species are found throughout the tropics. The distribution of each species significantly overlaps that of the other.
Hookworms are estimated to infect up to 1.3 billion people around the world depending on whose statistics you read. Most people who are infected are asymptomatic (without symptoms). Adult hookworms are very small, less than half an inch long and about half a millimeter wide. The most significant risk of hookworm infection is anemia secondary to loss of iron (and protein) into the gut but this only occurs in individuals with extremely high infestation levels or in those who are malnourished or immuno-compromised. Or all of the above.
A duodenale and N americanus are small (male: 8-11 mm, female: 10-13 mm), off-white worms. The sexes cannot be distinguished by the naked eye. Hookworm larvae (themselves invisible to the naked eye) emerge from embryos passed in stool within 24 hours and molt once to an infective filariform larval stage in another 24 hours. After molting, larvae are able to penetrate intact skin. The larvae can remain viable for up to two weeks on the ground.
Walking barefoot in soil contaminated with feces (the source of hookworm eggs/larvae) is the most common method of exposure. The other is inadvertent ingestion of contaminated feces. Note that the hookworm cannot proliferate in your gut, you can only increase your infestation level by coming into skin contact with larvae or ingesting contaminated feces. After skin penetration, the venous circulation carries larvae to the pulmonary bed, where they lodge in pulmonary capillaries. Within 3-5 days, the larvae break through into alveoli and travel up the ciliary escalator from the lungs into the bronchi, the trachea, and the pharynx. This often causes a violent cough such as I experienced. It woke me up, continued for about two hours and was so violent at its peak that I vomited into my mouth. Upon reaching the pharynx, larvae are swallowed and gain access to the GI tract. Once in the GI tract, worms attach to the wall of the lower intestine and begin to feed on the blood of the host. They are intestinal leeches.
Eggs begin to appear in the stool approximately 4-6 weeks after initial infection (assay of stool is the primary means of diagnosis). The lifespan of the worm is up to 1 year for A duodenale and up to 5 years for N americanus. The female produces 10,000-25,000 eggs per day during this time. Per day baby! What a machine. I have also read that the larvae can travel up through up to six feet of soil to reach the surface of the ground if stool is buried. One has to appreciate the remarkable durability of these creatures.
Hookworm infection is rare in the US and western Europe. Simply having toilets and sewers does for them because without feces contaminated soil they are out of business. The prevalence of infection is as high as 80% in lesser-developed countries with moist tropical climates (and lacking toilets) but is only 10-20% in areas with drier climates. Hookworm infection rarely is fatal (mostly in very heavily infected and malnourished children) but anemia can be significant in the heavily infected.
But, hookworm cannot proliferate in your intestine, the only way to increase the worm load is to come into skin contact with stage one larvae.
Hookworm can be cured with a two-day course of very cheap oral medication that is widely available.
How it works
So, how does hookworm cure these autoimmune diseases? I don't think anyone has worked that out precisely yet but the working theory, called the Clean Hypothesis goes something like this: Asthma and most autoimmune diseases are diseases of the west, and they are becoming much more common, fast.
Ironically, because we have been so successful in eliminating disease and parasites in Western Europe and North America our immune systems, which evolved in very dirty environments under constant assault from a multitude of diseases and parasites, goes awry absent these external modulators, and attack our own tissues.
Hookworm, as a foreign protein in contact with our tissues, has to suppress or modulate our immune response or it will be attacked and destroyed by our immune system. Think of that time you got a piece of hamburger stuck in a gum and did not have access to dental floss for the better part of a day. Remember the inflammation?
So, hookworm and these other parasites are down-modulating some aspect of our immune system, the result is no asthma, hayfever and Inflammatory Bowel Disease in individuals with sufficient numbers of hookworm. In effect, hookworm infestation suppress hay fever, asthma, colitis, Crohn's disease and Inflammatory Bowel Disease (IBD).
Really it isn't a cure since the effect only lasts as long as the infestation. Eliminate the worms and your asthma or Inflammatory Bowel Disease will return.
How I Obtained Hookworm and Cured my Asthma
Having decided that I was going to infest myself with hookworm I set about using internet resources to locate a supplier of hookworm embryos or larvae. The problem is that every government bureaucracy concerned with such things has been devoted to the elimination of hookworm since the 1920s. In addition it is a controlled organism (in Canada at least). None of the biological supply companies I was able to locate and contact carried live specimens of human hookworms, their larvae or embryos. The best I was able to locate were slides of dead examples.
Having hit a dead end I tried to contact the health departments in the southern states of the US, for Mississippi, Alabama, Georgia, etc, where hookworm used to be prevalent. The problem I ran into here is that hookworm is now very rare in the US and is not a reportable disease. So there is no requirement that health authorities track incidences of the disease. It undoubtedly exists I was told, but no one was able to tell me where. It is unlikely to be widespread anyway, just the introduction of toilets is likely to eliminate this parasite because it puts an end to the possibility that anyone might walk in contaminated soil. Puts the tropics in perspective.
I next contacted my doctor to ask his help. He turned me down after some consideration. The reason was that his malpractice insurance would have been revoked if he had helped me get infested. No insurance, no practice.
My requests to all my friends working as researchers, or the few graduate students I know were also denied. This was too far outside the then current orthodoxy for them to consider. WAY too far...
My attempts to enroll in the studies at Nottingham and Iowa were also fruitless.
At this point I came to the conclusion that short of bribing a research assistant or stealing samples from a lab I would have to go to the tropics and walk around barefoot in human excrement. Not an attractive proposition, but then neither is not being able to breathe, and the breathing thing was going to last the rest of my life.
But where to go to find these hookworm?
Intensive searches of the WHO website turned up just one map showing hookworm distribution in only one country: Cameroon.
I read extensively on Cameroon. By any measure it is one of the poorest places on the planet, although ironically relatively prosperous compared to most of its immediate neighbors. It is at best in the bottom quartile, but mostly in the bottom decile, for almost every measure of human welfare and economic well being that the UN and WHO measures.
Life expectancy is 47 years and declining, HIV/AIDs is approaching 20% which (given that half the population is under fifteen and presumably much less likely to be infected) means about about a third of the adult population has HIV). Hey baby!
The average annual wage is less than $700, it is at the epicenter for malaria and is afflicted with a legion of horrific diseases.
I found this ...off-putting... But I resolved to go. I spent almost a thousand dollars on vaccinations (although for the worst and most lethal diseases there are no preventive measures you can take, except to avoid the vectors of the disease, such as mosquitos for malaria and filharzia). For more information on the diseases prevalent in Cameroon you can start here. The highlights are malaria, dengue fever, river blindness, sleeping sickness, filharzia/elephantiasis, bilharzia (nasty!), rift valley fever, two varieties of hepatitis, cholera, typhoid and yellow fever. Filharzia is my least favorite, a mosquito born nematode (worm) that takes up residence in your lymphatic system and that if left untreated the worms proliferate and so clog your lymph system that your extremities swell with undrained lymph to produce elephantiasis. It is in incurable, but can be managed with treatment. I don't think I got it but I won't know until 2007.
Malaria and Dengue both have a mortality rate approaching 5%. Fortunately it appears that the only disease I caught was hookworm.
Still, I booked a ticket with Air France (flying with Air France was not a happy experience for me on this trip) from London to Paris, on to Douala and finally to the capital, Yaoundé. This was ridiculously expensive but there are effectively no choices for getting there. So I paid. First I had to get to London, I recommend Virgin Atlantic if you are flying from San Francisco or New York to London.
Being in the US I had to get my visa for Cameroon from the embassy in Washington DC. They are remarkably concerned with making sure visitors are going to leave their country and require far more documentation than the Americans ever did of me when I was an alien. Because time was short and because I live in California I used a visa facilitation service called Travisa to handle this for me, they got me the visa very promptly and for a reasonable fee. You can find their website here.
My Experiences in Cameroon in Brief
Cameroon is the third world, and the reality of statistics like those regarding incomes approaching a dollar a day are given a palpable reality as soon as you leave the airplane.
Africa is a constant assault on western sensibilities, from the open sewers or sewage running down the street, public urination, and lepers to the utter absence of law enforcement, EMT services, traffic lights and the insane and very dangerous driving habits of the locals. The only guidebook for Cameroon lists auto accidents as a leading danger for visitors. They aren't kidding. Having said that I loved it, but it probably isn't for most people.
Cameroon has no tourism infrastructure, its people being so poor (your pocket change represents two or three months wages) and the insane corruption make for a very challenging environment for a western traveler, particularly a conspicuous white one. You are a walking pile of cash, a visitor form another, much wealthier, planet. One feels very vulnerable and exposed. It can be very wearing and the danger of being robbed is constant.
This is a country where there is zero in the way of a safety net. If you are injured or beaten or robbed you are on your own. Dying, ignored in the street, is surely possible. Fortunately I met some very generous Cameroonians on the plane who invited me to stay with them. As they lived exactly where I wanted to go I headed for their place as soon as I woke up on my first day in Yaoundé, the capital. They had disembarked in Douala, the economic capital.
Traveling to the west of the country meant taking a bus along the main road between the capital and the economic capital, Yaoundé and Douala. The road was a two lane highway in good condition about equivalent to an A road in the UK or a county road in the USA. From there it was another half day to Limbe, the regional capital of one of two Anglophone provinces in the West.
Our hosts were the most amazingly generous and kind people one can imagine. They freely shared their house, knowledge and food, and showed us around. They were absolutely wonderful, as were most of the people I met in Cameroon. For instance they put a car and driver at my disposal, which proved invaluable in reaching the poorer and more remote areas where hookworm is prevalent. Without their help I am sure I would not have been successful. Thank you Richard and Sophie.
With the driver's help (I told everyone of my quest) I was able to visit a variety of villages and with practice learned to identify where the locals would defecate.
Almost no one owns a car, most cars are taxis, so everyone walks to work. Most workers are farmers or work in some kind of agriculture, and of course almost no one has plumbing never mind toilets, so when they leave the main road in the morning it is often time to relieve themselves.
So I looked for busy spurs off the main roads near population centers, villages. Sure enough, within about 50 meters of the main road there would be a variety of shared latrines. Meaning a clearing in the brush. I was able to avoid being stung or bitten by any of the worst types of insects, centipedes and reptiles while I was there, although the ants are enormous, aggressive and extremely painful. Luckily for me in the tropics excrement decays rapidly away to nothing, within 48 hours. Which is exactly the interval required for the hookworm embryos to become viable larvae. I have to admit that I stepped in a lot of excrement before I observed that. :-((
I became infested almost immediately, it must have been either the first or second day I spent walking barefoot through the latrines. When one thinks of it this was an enormous piece of luck. With an infection rate of below 20% even in this the most infected province of Cameroon, and the fact that infections are likely to be localized, and that a tiny fraction of one percent of the land is given over to contaminated soil, actually stepping in the right spot is quite a feat (no pun intended). Of course, I could not be sure without the tests almost two months later. So, I persisted with it for the remainder of my two-week stay. Having come that far I was not going to let my revulsion prevent my returning with hookworm in my body.
Seeing me the locals would often get fairly aggressive, wondering what the hell a white guy was doing walking around barefoot in their toilets. Still, I did get to meet a lot of interesting people. Unfortunately they were usually very intimidating, at least until they had calmed down. An angry man with a machete when you are standing isolated and alone in such an alien place is trying, particularly when you are compelled by circumstance to argue with him.
Five days after my first day walking barefoot I woke up at about 2 am coughing. For the next 2 hours or so I coughed, peaking in frequency and intensity about half an hour after I woke up. It built in intensity to the point that I vomited. It was a cough unlike any I have had. It was persistent and entirely unproductive (zero phlegm), and violent.
Six weeks after my return I tested positive for hookworm, but I still had asthma, so using the following techniques I increased my infestation level until my asthma and hay fever were cured.
How I Manage My Hookworm Infestation
While I do not know precisely how many hookworm I have, I do know when I don't have asthma (I imagine the same would be true for Inflammatory Bowel Disease (IBD), colitis, Crohn's, etc.). This unknown number of hookworm, n, is the number required to cure my asthma and hayfever (or Inflammatory Bowel Disease). There is another unknown number of hookworm, z, at which I would start to suffer from anemia. Obviously I want to keep the number at n or greater than n, but less than z.
Knowing when I don't have asthma is easy. And since hookworm cannot reproduce entirely in my intestines there is no danger of them proliferating and multiplying to the point where I develop anemia. Once I achieve a certain level of infestation coming into skin contact with the infections larvae that level of infection will only decline over time, unless I come into skin contact with more infections larvae. In order for me to increase my load of hookworm I have to deliberately infest myself with the larvae.
There are various numbers given for the life expectancy of each type of hookworm. The kind I have, Ancylostoma, is given a life expectancy of as little as one year by some authorities (and five years for N. Americanus). For me the greatest danger is that somehow my hookworm might all die (I would rather only go back to Cameroon when I can keep my shoes on, thank you), so I have adopted a three-month reinfection cycle to avoid this. That is once every three months I infest myself as described below.
To ensure that my infestation level is not too high and that I do not become anemic I simply get tested for anemia after each additional quarterly infestation and watch closely for the symptoms. I take iron supplements and make sure I eat well. No problems so far.
How I reinfest myself
I use a method I derived from some researchers in Australia, they used this method to obtain hookworm larvae for skin infestation so that their subjects could avoid coming into direct contact with feces contaminated soil. Simply, I have created a temperature and humidity controlled growing environment in which I mix my hookworm embryo containing feces with a moisture-bearing medium. After a few days I harvest the larvae using a bilayered material, peeling off the top layer that has not been in contact with the feces and applying this to my skin.
This method relies on the hookworm's instinct to climb and burrow to the top of whatever medium or material they are in so as to wait for a bare foot to land on them. Since they are capable by one account of penetrating up to six feet of soil penetrating the material does not represent a problem for them.
Having applied the top layer of this material to my flesh for an hour I invariably get the rash and cough associated with hookworm infestation at the right times. Stool tests confirm that I increase my infestation level when I do this.
That is pretty much it for me, today. If you want to get in touch or know someone who might you can email me at email@example.com.