Pod Insights Radiolab Your Friendly Neighborhood Hookworms About this episode For most of human history, people went about their daily lives with a worm or two (or fifty) in their guts. Only in the past century, with pharmaceuticals and sanitation practices, have we made significant strides towards deworming the whole of humanity. And that’s typically been thought of as a good thing, because having too many worms in your body can–quite literally–suck the life out of you.
But is it possible to have… too few worms? Science wonders if deworming ourselves has actually led to an increase in certain chronic diseases. On this episode, we dive into Necator americanus, a.k.a. the American Hookworm, and its mysterious relationship with each of us.
We trace the hookworm’s 118-year journey from a demonized economic depressant, to its use as a desperate D. I. Y. immunosuppressant, to its potential as a medical treatment for a number of chronic diseases, everything from asthma to MS.
We’re bringing back two stories from our 2009 episode Parasites plus new research on hookworms and autoimmune diseases, reported by Molly Webster
Special thanks to Ethan Hein for the use of his remix of Mozart's Piano Concerto No. 21. Plus, Doris Pierce, and Dan and Alice Hadley.
EPISODE CREDITS:
Reported by - Pat Walters and Molly Websterwith help from - {{wREPORTERS}}
Produced by - Matt Kielty
with help from - Rebecca Rand
Fact-checking by - Diane A. Kelly
and Edited by - Arianne Wack
EPISODE CITATIONS:
Articles -
Effect of experimental hookworm infection on insulin resistance in people at risk of type 2 diabetes (https://pubmed.ncbi.nlm.nih.gov/37495576/) by Giacomin PR et al. Nat Commun. 2023 Jul 26
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1:27 Speaker 03 Hey, I'm Latif Nasir.
1:28 Speaker 04 Hi, I'm Molly Webster and this is Radiolab.
1:31 Speaker 03 And what are we doing today, Molly?
1:34 Speaker 04 Okay, well, Latif, remember back in 2009? Before you and I both worked at the show, there was an episode called "Parasites".
1:42 Speaker 03 Oh my God, love that episode.
1:44 Speaker 04 It is really one of my favorites. And in that episode, we talk about this tiny, maybe creepy little worm called a hookworm.
1:53 Speaker 03 That's right.
1:53 Speaker 04 You remember it?
1:54 Speaker 03 Yeah, I mean, it like hooked into my brain.
1:56 Speaker 04 The hookworm hooked into your brain?
1:58 Speaker 03 It's the story of that one guy and then there's the final scene where he's walking through the...
2:03 Speaker 04 Oh, wait, okay, wait, wait, wait. You don't actually have to... 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 and human medical update.
2:24 Speaker 03 VH1, behind the music, "Where is the hookworm now?"
2:28 Speaker 04 Yes. Where is the hookworm and where is the human?
2:30 Speaker 03 Okay, great.
2:31 Speaker 04 This whole episode, it introduced this idea that this thing that we think is like the biggest, scariest, grossest pest of all time.
2:41 Speaker 03 Yeah.
2:41 Speaker 04 Maybe they're not as gross as you think.
2:43 Speaker 03 Yeah.
2:43 Speaker 04 And now, 20 years later, people are saying, maybe they're really not as gross as you think.
2:50 Speaker 03 Love it.
2:51 Speaker 04 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.
3:01 Speaker 03 That, as you know, is one I'm particularly interested in. But, um, well, yeah, I'm, I'm, I'm sold. I would like to hear more.
3:09 Speaker 04 Okay, great. So I'm gonna play the original hookworms segment, just so we all know what's going on, and then we'll jump into an update in about 20 minutes.
3:17 Speaker 03 Okay, great.
3:18 Speaker 02 Wait, you're listening?
3:20 Speaker 03 Okay.
3:21 Speaker 02 All right.
3:22 Speaker 05 Okay.
3:24 Speaker 02 All right.
3:25 Speaker 05 You're listening to Radiolab.
3:28 Speaker 02 Radiolab.
3:29 Speaker 05 From... WNYC. See? Rewind.
3:38 Speaker 06 Hello, I'm Jadab Womron.
3:39 Speaker 07 And I'm Robert Krulwich.
3:40 Speaker 06 This is Radiolab. Our topic today?
3:42 Speaker 07 Parasites.
3:43 Speaker 06 Parasites.
3:44 Speaker 07 Now, we've met them, they're nice, and we've met them when they're not so nice.
3:47 Speaker 06 I don't know that we've met any nice ones, really.
3:50 Speaker 07 Oh, we haven't? I thought, I thought that...
3:51 Speaker 06 Oh, the blood flukes. They were pretty nice.
3:54 Speaker 07 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...
4:02 Speaker 06 Invisible.
4:02 Speaker 07 Invisible and sort of offstage.
4:04 Speaker 06 Yeah.
4:04 Speaker 07 But when you back off a little bit and consider them, you know, and the effects that they have on the world?
4:10 Speaker 06 They're actually these powerful sculptors of monumental narrative.
4:15 Speaker 07 In other words, these are little guys telling very big stories.
4:20 Speaker 06 In fact, here's an example. Recently, I went to visit a guy named Dixon Despommier.
4:26 Speaker 06 But Columbia University, he's a parasitologist and, well, he does a bunch of different things. We ended up talking about, um, well, he told me this crazy story.
4:36 Speaker 04 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.
4:56 Speaker 03 The story I love telling the most is how we eradicated hookworm.
5:01 Speaker 06 The story begins in 1908.
5:03 Speaker 03 John D. Rockefeller, Sr.
5:05 Speaker 06 Really rich guy is sitting in his New York office and he's thinking.
5:08 Speaker 03 How can I make more money selling something to the South?
5:12 Speaker 06 Yeah, I've got all this money, got all these resources. I just need a new market. And in terms of new markets, the South was pretty much untapped. If only those damn Southerners.
5:21 Speaker 03 Just get off their butts and get going.
5:24 Speaker 06 Problem was, they weren't. They weren't getting off their butts.
5:27 Speaker 03 The farms were not operational, the economic engine was turned off.
5:32 Speaker 06 The economy was in the toilet. And so John D. Rockefeller wanted to know why. Why aren't they producing more?
5:37 Speaker 03 Yep. What's happened to their economic engine?
5:40 Speaker 06 So he thought.
5:41 Speaker 03 I know, I'll form a commission.
5:42 Speaker 06 Yeah.
5:42 Speaker 03 So he sent out 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, we don't exactly know what's wrong, but we think that these people are sick from something because they don't, they don't behave like we do.
6:08 Speaker 06 What does that mean?
6:09 Speaker 03 They are slow.
6:12 Speaker 03 Not mentally, they're slow physically, they're pale. I'll give you an example. You remember the movie Deliverance?
6:18 Speaker 06 Sure.
6:18 Speaker 03 Okay. Remember that little guy that played the banjo?
6:22 Speaker 06 I remember the other scene that we all remember.
6:24 Speaker 03 Yeah.
6:25 Speaker 06 We're not going to talk about that.
6:25 Speaker 03 No, we're not. No, we're not. But if you can recall what that little banjo player looked like.
6:33 Speaker 03 Looking guy, but he looked old.
6:35 Speaker 06 Sickly pale.
6:36 Speaker 03 Yeah, sickly pale and yet an adult.
6:37 Speaker 07 Well, wait a second, that is not a description of all Southerners.
6:41 Speaker 06 No, no.
6:42 Speaker 07 It was a description of one teeny corner in a.
6:43 Speaker 06 No, but what the commission did say about a lot of these Southern people that they encountered is that a lot of them, they just don't look right. They looked weak, they looked wan, they looked kind of wan, wan.
6:53 Speaker 07 Wan, they were wan.
6:55 Speaker 06 Pale, lethargic.
6:56 Speaker 07 It's interesting, wan or wan?
6:58 Speaker 06 Wan.
6:58 Speaker 07 You choose.
6:59 Speaker 06 So the thought was that maybe these Southerners had some kind of laziness disease. This is really what a lot of folks thought. But one member on the committee suggested to Rockefeller, you know what? Perhaps these people are anemic.
7:10 Speaker 03 Anemic, they're anemic, you say? Yeah, they're anemic. Sounds like a medical problem then. Maybe they're not lazy after all, maybe they're anemic and maybe they're just weak.
7:21 Speaker 06 Next thing you know Rockefeller puts together another commission.
7:23 Speaker 03 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 loamy soils, anemia. Hard packed clay soils, hmm, no anemia. Sandy loamy 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.
7:48 Speaker 06 And this seemed to be a clue. The incidence of anemia was linked somehow to the soil, maybe. Bum, bum, bum.
7:55 Speaker 07 Yes.
7:56 Speaker 06 Something was in the soil.
7:57 Speaker 03 That's correct. So somehow they hit upon this idea of looking for hookworm.
8:04 Speaker 06 The hookworm.
8:05 Speaker 03 The hookworm.
8:09 Speaker 06 So they thought, all right, let's run some tests.
8:11 Speaker 03 And when they did, big time, they discovered hookworm big time.
8:17 Speaker 03 So the anemia is due to hookworm.
8:21 Speaker 06 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. Because if these hookworms are in you, they're going to come out of you when you go to the bathroom. So they asked these Southerners, when you guys defecate, where do you do it?
8:40 Speaker 06 Most of them said something like this.
8:41 Speaker 03 And I defecate over there. You see that tree over there? That's where I defecate. So I defecate over there, but I live over here.
8:48 Speaker 06 Okay, so then the investigators asked the next question. When you go to that tree and do it, do you, do you wear any shoes? Most of them said, no.
8:56 Speaker 03 Barefoot, just like everybody else. Because it's.
9:01 Speaker 06 So clearly, these worms are in the feces that are landing near the tree, that are 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 meant...
9:15 Speaker 02 Oh my goodness, oh my goodness, it can crawl. Right, so let's find out how far it can crawl.
9:23 Speaker 06 So what they did, these researchers, is they built a sandbox. And then they took some hookworm-infested 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's 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 crawled an entire foot, in all directions, but they weren't at two feet. On day two, my god, they're at two feet. At day three, they're at three feet! I can't believe this, they're crawling a long way! Day four, they crawled to four feet.
10:07 Speaker 06 What about day five?
10:09 Speaker 02 I'm allowed to ask that. And what about day five?
10:13 Speaker 06 Five feet?
10:14 Speaker 02 No.
10:15 Speaker 06 No? Four feet?
10:18 Speaker 02 That's it. 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 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.
10:52 Speaker 06 Because if the worms can only make it four feet, well then that's two feet past the point where they die.
11:00 Speaker 02 We call that the outhouse.
11:05 Speaker 02 And in fact Rockefeller got his wish. The South did rise again.
11:11 Speaker 06 That sounds too easy to me, though. You're telling me that an understanding of hookworm, which created the outhouse, removed the quote "southern laziness disease" and they did rise?
11:20 Speaker 02 It did.
11:21 Speaker 06 And you bring that all back to the hookworm?
11:23 Speaker 02 I do.
11:23 Speaker 06 Really?
11:24 Speaker 02 No, I bring it back to sanitation.
11:26 Speaker 06 Now, to be fair, you can find plenty of other reasons why the South rose again.
11:29 Speaker 07 Air conditioning and highways and universities and stuff like that.
11:33 Speaker 06 So the hookworm had some help. But what is clear is that when we, as a country, began to distance ourselves from our own excrement, to put it bluntly, when we stopped walking around in our own [BLEEP], there were all of these unintended consequences.
11:46 Speaker 02 Salmonella disappeared, Eusthelytica disappeared, Chigella disappeared, cholera disappeared, Giardia disappeared, Cryptosporidium, anything that's associated with parasites and feces disappeared. Every time we built outhouses and people used them religiously, guess what? Their kids could stay in school longer, they could learn more, they got ahead faster.
12:32 Speaker 06 Dixon Desmoyet is a professor of public health in the environmental health sciences and microbiology at Columbia University.
12:39 Speaker 07 Can they make longer titles at that university?
12:42 Speaker 06 He literally wrote the book on parasites.
12:44 Speaker 07 The book is called Parasitic Diseases, you know it very well, and soon to be a major motion picture, but now in its fourth edition.
12:51 Speaker 06 In its fourth edition.
12:52 Speaker 07 And while we're on the subject of hookworms and the glorious campaign to de-worm 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 Pat, are you there?
13:16 Speaker 03 Yeah, I'm here, Robert.
13:17 Speaker 07 So tell us a little bit about this fellow, what's his name exactly?
13:21 Speaker 03 His name is Jasper Lawrence.
13:22 Speaker 07 That's right, Jasper Lawrence.
13:24 Speaker 03 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 airborne allergens that they would feel like they were swelling shut. I could feel my eyes squeaking in my sockets. It was an enormously uncomfortable feeling. But it was nothing debilitating. They were just allergies. So, you know, he's just like, like most other people have allergies, just learn to deal with it. You know, you live with it. But. What changed for me in my late twenties, early thirties was my asthma.
14:03 Speaker 03 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 a landscaping business. I really didn't want to work for someone else. Someone with allergies, starting a landscaping business, that seems kind of unexpected. Stupid is actually the word for it.
14:25 Speaker 03 And within six months or a year. He starts to notice. This really weird barking cough. Was there anything particular that brought this on? No, it was, it was just sitting and breathing. Cats 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 Singulair 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, I looked terrible. I had dark eyes and pale, waxy skin. I had that allergic look. It was a really bad time.
15:10 Speaker 03 And he decides in the summer of 2004 to take a vacation. You made this visit to, to England? Yeah. I took my two daughters back to see my aunt who'd raised me. Very early in the visit. I was sitting at her kitchen table and she asked me if I'd seen a BBC documentary about parasites and their connection with things like asthma and allergies, multiple sclerosis. And of course I hadn't, but I went upstairs and got on the internet after lunch. And I stayed on the internet until perhaps 2:00 in the morning. I didn't stop.
15:46 Speaker 07 And he's reading and reading and...
15:48 Speaker 03 The work of all these researchers.
15:49 Speaker 07 One study after the next.
15:50 Speaker 03 Japan, epidemiological studies in Africa, animal models of 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.
16:14 Speaker 07 Hookworm?
16:15 Speaker 03 Yeah, hookworms. Yeah, I learned that asthma was 50% less likely in someone who had a hookworm infection. So this sort of just like hits you. Oh, yeah. What did you think when you, when you read that? Oh, I immediately was determined to obtain a 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 you 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
16:56 Speaker 03 your blood, and eventually end up down in your gut and start chewing on the inside of your intestines.
17:03 Speaker 07 This guy wants hookworms in his intestines?
17:06 Speaker 03 Absolutely. And so you just Google it? Yeah, hookworms for sale. I mean, you know, someone's got to be selling them, but nothing. I contacted every laboratory supply company in the world and parasitology research centers and they all said the same thing. No, various flavors of no.
17:25 Speaker 05 So I came to the conclusion that I was gonna have to go to the tropics.
17:29 Speaker 03 So, fast forward a little. Jasper is in Cameroon, along the coast.
17:33 Speaker 05 Quite literally and figuratively, the armpit of Africa.
17:36 Speaker 03 He's 200 miles north of the equator. It's extremely hot. He finds a guy to drive him around. And so he and his driver would go to a village.
17:45 Speaker 05 He'd get out of the car.
17:46 Speaker 03 Walk up to these villagers and ask them if they could see the latrine.
17:52 Speaker 05 Just an open area of ground, usually with bushes so people can have a little bit of privacy. And I would go over to the area, remove my shoes, and start walking. The first time I did that, I, uh, I almost couldn't do it.
18:09 Speaker 05 It was, 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.
18:33 Speaker 03 How many villages, latrines, do you think you visited?
18:36 Speaker 05 Between 30 and 40.
18:40 Speaker 03 Jasper spent two weeks there, walking around in village latrines, and then he flew home.
18:48 Speaker 05 I got back from Africa in early February. So I was looking at allergy season coming up. And the day I realized that I no longer had allergies, it was such a good day. I got into my car and I started driving and I had the window down. You know, 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 phlegm was gonna be pouring out of every orifice in my face. And it didn't happen.
19:19 Speaker 05 It didn't happen.
19:22 Speaker 05 I just started screaming in the car. I was so, so happy.
19:33 Speaker 05 And I haven't had an asthma attack since I went to Africa.
19:38 Speaker 05 I no longer have allergies.
19:46 Speaker 05 The vast majority of the benefit that I've experienced has come from hookworm.
19:50 Speaker 07 What is the hookworm doing? Do you know?
19:53 Speaker 03 Well, so the immune system that we learn about in elementary school is all about like these attack cells that go after foreign invaders and destroy them.
20:01 Speaker 07 Right.
20:02 Speaker 03 And that's a big, important part of the immune system. But if the immune system were allowed to attack and destroy things unchecked, it 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. Allergies and asthma are just two of these. Some of the more serious ones are like type 1 diabetes, multiple sclerosis, Crohn's disease, in which the immune system actually starts attacking the inside of the intestines. There are like 80 of these diseases.
20:29 Speaker 07 Eighty of them.
20:30 Speaker 03 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 just quiet things down and tell the attack cells to stop attacking.
20:58 Speaker 07 So these are like lullaby cells?
21:00 Speaker 03 Exactly. What lots and lots of scientists think, Joel Weinstock.
21:05 Speaker 07 Tufts Medical Center.
21:06 Speaker 03 And dozens of others, is that over
21:09 Speaker 07 Thousands and thousands of years.
21:11 Speaker 03 Hookworms almost developed in tandem with the human immune system.
21:15 Speaker 07 Co-evolution. Parasites living within your body, your immune system changes.
21:20 Speaker 03 So you got to a point where the hookworms could survive safely.
21:24 Speaker 07 Worm gets a home, there's food.
21:26 Speaker 03 Coming down the food pipe and in return. The human immune system gains some kind of Some form of Positive regulatory Advantage.
21:39 Speaker 03 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.
21:54 Speaker 07 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 wormies in us.
22:04 Speaker 03 Yeah, this is called They call it the hygiene hypothesis.
22:07 Speaker 07 The hygiene hypo- that we're not dirty enough.
22:10 Speaker 03 Too clean.
22:11 Speaker 05 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 for millions of years.
22:22 Speaker 03 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 for making us well.
22:38 Speaker 07 So then what does Jasper do about all this?
22:40 Speaker 03 He decides to start a business selling hookworm to people.
22:44 Speaker 07 What?
22:44 Speaker 03 You can call him up and he will literally FedEx a dose of hookworms to your door.
22:50 Speaker 07 How?
22:51 Speaker 06 Sorry to break in for a second. Pat?
22:53 Speaker 03 Hi, Jad.
22:53 Speaker 06 Where does he get the hookworm from?
22:55 Speaker 03 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?
23:11 Speaker 05 Well, it's a very easy organism to work with. It just, it 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 having done that, I repeatedly wash them in solutions of antibiotics to make sure that anything that 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. Necessary to infect themselves.
23:37 Speaker 07 To a certain extent, is this a safe thing to do?
23:40 Speaker 03 Jasper, Jasper has done tons and tons of research, but he's not a doctor.
23:44 Speaker 07 Right.
23:44 Speaker 03 The treatment is not approved by the FDA.
23:47 Speaker 07 That's what I wonder, is there any serious sort of double-blind study trying to figure out whether some safe delivery of hookworm might make sense?
23:55 Speaker 03 Yeah, so one of, one of the guys who was sort of a pioneer in this hookworm research is David Pritchard. I'm Professor David Pritchard. Immunologist 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 under our belts, but we've yet to conduct the trials to show that 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 10 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 that 10 worms were tolerated.
24:40 Speaker 03 But Pritchard, when he did this proof of safety study, actually gave himself 50 hookworms.
24:46 Speaker 07 Oh.
24:47 Speaker 03 Which put him out of commission for a while. Well, I, I felt pretty bad. I mean, pain in the gut, really, you know, you could feel them because 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, and the side effect that makes them sort of a public health enemy is that they can give you anemia.
25:08 Speaker 03 So if you have too many, you, you lose quite a bit of blood to these parasites?
25:12 Speaker 05 Well, you know, if you take too many hookworm, which you're not going to, if you come to us, the worst thing you're going to 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.
25:23 Speaker 03 Jasper's kind of just gone for it, you know, it's a very sort of like cowboy move.
25:27 Speaker 05 So the scientific community, I think they believe that I'm premature.
25:31 Speaker 07 It's not FDA approved.
25:33 Speaker 05 In offering this to the public.
25:34 Speaker 07 You don't know what it is, you don't know it's.
25:36 Speaker 03 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 Jasper also says he's seen success with a few multiple sclerosis patients and several Crohn's disease patients, too. Like, how many people do you think that you have infected?
25:54 Speaker 05 It's about 85 right now.
25:56 Speaker 03 How is business?
25:58 Speaker 05 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.
26:14 Speaker 03 The way he sees it, people are scared.
26:16 Speaker 05 Well, there are the people who are coming from a point of view of what they learned in kindergarten about clean drinking water and sewers. To them, worms and parasites are so repulsive that there's nothing good to be said about them. But I can make you better. It's simple, it's cheap. I mean, for God's sake, these organisms fall out my rear end every day, a half a million at a time. The raw material is human excrement, for God's sake. All people have to do is open their minds. Are you really that scared of a little worm?
27:00 Speaker 03 Okay, okay, okay, okay.
27:01 Speaker 04 So that's it?
27:02 Speaker 03 So, so wait, but, okay.
27:04 Speaker 04 Yeah, maybe the, maybe the question is, Latif, you have talked about this on the show, you have an autoimmune disorder.
27:10 Speaker 03 Yes.
27:10 Speaker 04 Crohn's disease.
27:11 Speaker 03 Crohn's disease, yeah.
27:12 Speaker 04 You've heard this piece. Are you scared of a little worm?
27:15 Speaker 03 I mean, I am intrigued. I am, 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.
27:27 Speaker 04 All right, well, then I am going to tell you about a clinical trial, and then you can tell me what you think, but after the break.
27:34 Speaker 03 All right, oh, after the break, all right.
27:35 Speaker 04 After the break, a clinical trial.
27:37 Speaker 03 I'm, I'm ready, I'm excited.
27:39 Speaker 04 Okay.
27:40 Speaker 03 Great.
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30:02 Speaker 04 Latif, we are back from break.
30:04 Speaker 03 Yeah.
30:04 Speaker 04 And we left you at, are you scared of a little worm?
30:07 Speaker 03 And I was like, maybe, maybe, I don't know. Let's do some actual clinical trials.
30:13 Speaker 04 And that is what like, okay, so that episode was done in 2009.
30:17 Speaker 03 Right.
30:17 Speaker 04 And so I want to fast forward to today. There have been a number of clinical trials.
30:22 Speaker 03 Okay, so what, what happened?
30:23 Speaker 04 Okay, so, hi.
30:25 Speaker 03 Hey, how are you?
30:27 Speaker 04 I talked to this researcher.
30:29 Speaker 03 Dr. Paul Jackerman.
30:30 Speaker 04 Paul Jackerman.
30:31 Speaker 03 Senior Research Fellow at the Australian Institute of Tropical Health and Medicine.
30:36 Speaker 04 And he's basically trying to do like the next iteration of
30:41 Speaker 03 Jasper.
30:42 Speaker 04 Of like Jasper, but like with, with actual scientific studies and stuff.
30:46 Speaker 03 Okay, yeah. Yeah, trying to understand the potential beneficial effects of worms in people.
30:50 Speaker 04 So one of the things that he's been studying is
30:53 Speaker 03 Treating people who are at risk of type 2 diabetes with hookworms.
30:57 Speaker 04 Hmm, so type 2 diabetes, that's the diabetes you typically get later in life?
31:00 Speaker 03 Yeah.
31:01 Speaker 04 What made you pick diabetes?
31:02 Speaker 03 It sort of came on the back of research which started in the 2010s where people went into regions of the world where parasitic worms are really common.
31:11 Speaker 04 And what they found is that there is a correlation between something like type 2 diabetes and the presence or lack of worms.
31:19 Speaker 03 Huh, yeah, so basically
31:21 Speaker 04 So what Paul and his team did is basically they took people who are at risk for type 2 diabetes and they gave them hookworms.
31:28 Speaker 03 How do they give it to them? How do they take them? Do you like slurp it down like a little piece of spaghetti?
31:33 Speaker 04 No.
31:33 Speaker 03 You know, people think where they're going to enroll, they're going to have to swallow a worm or swallow worm eggs, et cetera, so.
31:38 Speaker 04 It's actually much worse, or, I don't know, it could be much better than that.
31:42 Speaker 03 Basically, in order to do our research.
31:44 Speaker 04 The first step of the process is they have folks who work in their lab.
31:50 Speaker 03 These what called worm farms.
31:53 Speaker 04 Volunteers.
31:53 Speaker 03 Who've consented to have a small number of worms.
31:56 Speaker 04 Living inside of them.
31:58 Speaker 03 Oh, wow. Yes, exactly. The only way, you can't culture them, you can't just get them and freeze them.
32:03 Speaker 04 Really?
32:04 Speaker 03 Yeah, so based, that's one of the limitations about working with these worms. You actually have to maintain, we call them worm farms. So like hazard pay for? For that, like, what, do they get a bonus?
32:14 Speaker 04 No, I think they're just very generous volunteers.
32:17 Speaker 03 Brave and dedicated volunteers. And so that if we want to do our research, we say, hey, generous volunteer.
32:25 Speaker 04 Can you give me a sample of your stool?
32:28 Speaker 03 Okay.
32:29 Speaker 04 Because what happens in these people in the worm farms is the hookworms inside of them will mate.
32:36 Speaker 03 And they can produce, the females can produce tens of thousands of eggs every day, which are released eventually in the poo. Huh.
32:44 Speaker 04 And so they poop.
32:45 Speaker 03 We get the poo sample.
32:46 Speaker 04 Add charcoal to it.
32:47 Speaker 03 Which reduces the smell. And then we spread it onto the petri dish.
32:51 Speaker 04 They leave the petri dish in sort of like, kind of a humid tropical environment.
32:55 Speaker 03 Okay.
32:55 Speaker 04 It sits there for a week.
32:57 Speaker 03 And over the course of that week.
32:59 Speaker 04 These tiny hookworm eggs start to hatch. And emerging from them are these.
33:06 Speaker 03 Microscopic.
33:07 Speaker 04 Teeny tiny baby worms.
33:09 Speaker 03 Barely visible to the naked eye.
33:11 Speaker 04 And very quickly, Paul and his team hit them.
33:13 Speaker 03 With like a strong disinfectant.
33:15 Speaker 04 To clean them.
33:16 Speaker 03 Then we can basically look down the microscope. We just one by one pick the wriggly worms, put them into a little tube.
33:22 Speaker 04 And then what they do is they put the worms on a Band-Aid, essentially.
33:29 Speaker 03 Uh huh.
33:29 Speaker 04 And they take that Band-Aid and they put it on the skin of the patients that are enrolled in the clinical trial.
33:35 Speaker 03 Oh, but not even on a cut, just anywhere on the skin?
33:38 Speaker 04 Just anywhere on the skin.
33:39 Speaker 03 And then we sort of sit with them for about five minutes because participants start to get this tingling sensation.
33:45 Speaker 04 Because what happens is these baby worms on the Band-Aid start to release an enzyme.
33:51 Speaker 03 Which degrade tissue.
33:53 Speaker 04 Which basically melts your skin so that they can start to burrow.
33:57 Speaker 03 Ah.
33:58 Speaker 04 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
34:12 Speaker 03 The lymphatics.
34:13 Speaker 04 Your lymphatic system. So if you think of the inside of your body as a water park,
34:19 Speaker 03 Uh huh.
34:20 Speaker 04 As one does, the lymphatic system is like the lazy river.
34:23 Speaker 03 Sure, yeah, yeah, yeah.
34:24 Speaker 04 So these baby hookworms 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.
34:41 Speaker 03 That's funny.
34:42 Speaker 04 And they're floating downstream.
34:43 Speaker 03 Uh huh.
34:44 Speaker 04 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.
34:59 Speaker 03 And once they're going into the blood, they're cruising around like on a water slide.
35:03 Speaker 04 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 thud, thud, thud 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 until
35:24 Speaker 03 Yeah.
35:25 Speaker 04 These little baby worms get stuck. They get trapped inside a super tiny blood vessel.
35:30 Speaker 03 Because they're too big.
35:32 Speaker 04 Yeah, they're too big for the blood vessel, so they get stuck there.
35:35 Speaker 03 Their journey ends.
35:36 Speaker 04 But Paul says
35:37 Speaker 03 That's their cue.
35:38 Speaker 04 To again, release an enzyme that starts to melt away the walls of the blood vessel.
35:43 Speaker 03 Whoa.
35:44 Speaker 04 Just enough, they can wriggle their way through and then pop out on the other side of this blood vessel and into your lungs.
35:55 Speaker 03 And then what they do is they crawl
35:57 Speaker 04 They crawl.
35:57 Speaker 03 Up through the lung, all the airways.
35:59 Speaker 04 Like a rock climber. Boop, boop, boop, boop, boop, boop, boop.
36:03 Speaker 03 Up your trachea.
36:04 Speaker 04 So they're almost in your throat.
36:06 Speaker 03 And then unknowingly.
36:07 Speaker 04 One day you will.
36:11 Speaker 04 Cough, which will dislodge these worms from your trachea up into this little free space in your throat, where I like to think that they will do a backward somersault. And then after you cough, you usually swallow.
36:25 Speaker 03 So yeah, you'll swallow them.
36:26 Speaker 04 You swallow the worms.
36:27 Speaker 03 Oh, my God.
36:28 Speaker 04 At which point they will shoot down your esophagus into your stomach.
36:32 Speaker 03 Oh, my God.
36:33 Speaker 04 And then once it's-
36:34 Speaker 03 Why wouldn't you ju- oh, but it's like, why wouldn't you just feed it to people then? Well, like, why do this whole crazy-
36:39 Speaker 04 Well, because this whole process from skin to gut takes about two to three weeks. And during that process, the worm is maturing.
36:47 Speaker 03 Got it.
36:48 Speaker 04 And so it's actually developing in such a way that it can survive in your stomach.
36:52 Speaker 03 I see. So it's like, this is how it develops?
36:54 Speaker 04 Exactly.
36:55 Speaker 03 So it's a really fascinating life cycle. They can survive the stomach acid. And then they sort of make their home in the upper, just beyond the stomach there, in their upper small intestine.
37:05 Speaker 04 And once they're in the small intestine-
37:07 Speaker 03 They've got these sort of quite violent looking teeth.
37:10 Speaker 04 They will bite and clamp onto you.
37:12 Speaker 03 And they very fairly delicately just sort of suck the blood.
37:15 Speaker 04 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.
37:23 Speaker 03 Uh huh.
37:24 Speaker 04 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.
37:51 Speaker 03 And we've, we've actually in some of our clinical trials, have taken a camera and we've had a look in the gut at regions of the gut where the worm's 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.
38:11 Speaker 04 Really?
38:12 Speaker 03 Yeah, absolutely. It's in their best interests to basically feed and heal the wounds in their environment.
38:18 Speaker 04 So the really cool thing is, is that- When this hookworm reaches adulthood and it's bit on to 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.
38:33 Speaker 03 Wow.
38:33 Speaker 04 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.
38:43 Speaker 03 Because your immune system could, it could just unleash an enormous, you know, attack on these worms.
38:49 Speaker 04 But obviously, the worm does not want that.
38:51 Speaker 03 Yeah.
38:52 Speaker 04 And so it has these little proteins that's a crease that tells your immune system, shh, 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.
39:09 Speaker 03 I feel like you've 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 story of like Mission Impossible on a worm scale. Like, I'm like, how can this thing like vault over this, but then say the right words to this person that they'll leave them alone? And then, and then climb up the da-da-da, and then da-da-da-da. 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.
39:37 Speaker 04 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.
39:46 Speaker 03 The people who were treated with the hookworms had things like reduced glucose levels, and they had dramatically reduced insulin resistance levels, lost a little bit of weight.
39:55 Speaker 04 And some of these people who were considered prediabetic were no longer prediabetic.
39:59 Speaker 03 Oh, wow. So some people were cured effectively.
40:01 Speaker 04 Yeah, basically.
40:02 Speaker 03 Well, when you look at the placebo people who got no worms.
40:05 Speaker 04 They went on to continue having high insulin resistance, glucose.
40:09 Speaker 03 All the problems.
40:10 Speaker 04 No weight loss.
40:10 Speaker 03 So it was really the first causal clinical evidence that the worms were having a benefit on metabolic health.
40:17 Speaker 04 Then, at the end of the trial, the end of the two years, the people who had the hookworms inside of them, they have the option to just get rid of the worms. Like, you can take an over-the-counter deworming medication and they'll be gone the next day.
40:31 Speaker 03 Yeah.
40:32 Speaker 04 Paul says at the end of this two-year study, almost everyone kept their worms. Wow.
40:37 Speaker 03 They were happy at the end. They wanted to 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.
40:48 Speaker 04 Do you think the happiness is emotional? Or do you think the happiness is like they actually feel different?
40:54 Speaker 03 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. And the other thing is we've, you know, in our two most recent clinical trials, which were placebo-controlled.
41:05 Speaker 04 So these trials were looking at celiac's disease?
41:08 Speaker 03 Yeah, we asked people to do a quality of life and mood and wellbeing survey. And in both clinical trials, we had this really interesting improvement in wellbeing and mood and sleeping quality.
41:25 Speaker 04 Wait, really?
41:26 Speaker 03 That we saw in the people with the worm treatment. And the placebos, we didn't see it. I can't explain it, but you know, the data was there and it's really compelling.
41:36 Speaker 04 And there is like. What a weird thing, right? I know. So one, well, 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. 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 macrobiome.
41:57 Speaker 03 You know, the macrobiome, the organisms that you can see with your naked eye, these worms that can, you know, somehow live for up to a decade or even longer within our gut. The immune system should really have recognized these worms and kicked them out because they're such a big insult on the body.
42:13 Speaker 04 But Paul says it could be that when these worms, when they reach 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.
42:28 Speaker 03 Yeah.
42:28 Speaker 04 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.
42:47 Speaker 03 Right.
42:48 Speaker 04 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.
42:56 Speaker 03 Yeah, yeah, yeah.
42:57 Speaker 04 Then overall, it's just the immune system's not going to attack you.
43:01 Speaker 03 I just, this is, the thing that's really confusing to me is why?
43:06 Speaker 04 We've left you more confused.
43:08 Speaker 03 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?
43:31 Speaker 04 What do you mean, outsource?
43:32 Speaker 03 Like, outsource, like, the worms are not us. Like, if they're, if they're helping regularly.
43:37 Speaker 04 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.
43:50 Speaker 03 Yeah.
43:50 Speaker 04 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.
43:58 Speaker 03 Right.
43:58 Speaker 04 And then a worm got inside of us and it lasted a little longer.
44:01 Speaker 03 Yeah.
44:02 Speaker 04 And then we did or did not die. And it's like basically this long-term dance
44:10 Speaker 04 between us and the worm.
44:13 Speaker 03 So there's this really interesting truth that's happened throughout evolution, where the worm benefits and the host benefits.
44:19 Speaker 04 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.
44:30 Speaker 03 But also it's from the potential immune shaping and metabolic shaping powers of the worm.
44:37 Speaker 04 So Paul's lab has shown that people who are given hookworms have fewer symptoms associated with type 2 diabetes, celiac 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, Crohn's disease, latif. And in those studies, some people have gone into remission with worms. That's not Paul's lab, but that's other labs. Yeah.
45:06 Speaker 03 And if they're beneficial, and why not turn it into a treatment?
45:11 Speaker 04 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.
45:25 Speaker 03 Yes, there's a lot of hurdles for developing hookworms as a medicinal treatment.
45:30 Speaker 04 Everyone is kind of like, listen, there's so many reasons why people don't want worms. Like, they're kind of just gross.
45:37 Speaker 03 But also, I briefly mentioned before, you get the larvae out of people's poo. So making a medicinal product.
45:43 Speaker 04 With standardization and decontamination, it's just really hard.
45:47 Speaker 03 Exactly. So at this stage, it's probably never going to be a mainstream treatment.
45:53 Speaker 04 In fact, Jasper, who we had mentioned was selling worms. He and his wife actually fled the US 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 produce to heal your gut or quiet 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 timetable for that is. And so for now, you really are just stuck with having to get a hookworm.
46:34 Speaker 03 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 tested and it hasn't gone through the regulatory processes that other medications need to go through.
46:51 Speaker 04 And so, yeah. That's where, that's where it's at.
46:55 Speaker 03 Okay, but, okay, I gotta go, but my last question is, Molly, should I get a worm?
47:00 Speaker 04 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 and get into one of Paul's?
47:09 Speaker 03 Um, I think that-
47:11 Speaker 04 I'll tell you the areas that they're doing it in. The big research areas are like the Netherlands,
47:17 Speaker 03 uh-huh.
47:17 Speaker 04 Australia, New Zealand. You got any trips there planned soon?
47:21 Speaker 03 No, now I'm just, you know, just those lucky people over there that get worms, you know?
47:27 Speaker 04 Well, you know, you could always do what Jasper did, which is just go walk around in some poop and pick up, you know, hookworms plus roundworms plus tapeworms. You know, that's an option.
47:38 Speaker 03 No, that's not, I'm not gonna, I'm not gonna roll in, uh, uh, human feces.
47:44 Speaker 04 That was a, that's a level of desperate you're not at?
47:47 Speaker 03 That's not how desperate I am.
47:48 Speaker 04 Okay, well, Australia it is then. Okay, hitting stop.
47:52 Speaker 03 Okay.
47:52 Speaker 04 Okay, hitting, hitting stop.
48:00 Speaker 03 Okay, thank you, Molly Webster, for the update.
48:03 Speaker 04 You're welcome.
48:04 Speaker 03 Update was produced by Matt Kielty with help from Rebecca Rand. It was edited by Ariane Whack and fact-checked by Diane Kelly.
48:13 Speaker 04 And we want to thank Pat Walters, Jad Abumrad, Robert Kowicz, 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.
48:26 Speaker 03 And for everything else, Radiolab-y, please subscribe to our totally FDA-approved newsletter. All right, we'll be right back-
48:34 Speaker 04 In 20 years.
48:35 Speaker 03 In 20 years.
48:37 Speaker 04 No, just next week.
48:38 Speaker 03 Yeah, we'll catch you next week.
48:39 Speaker 04 Bye.
48:41 Speaker 03 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. Sauron Wheeler is our executive editor. Sarah Sandback is our executive director. Our managing editor is Pat Walters. Dylan Keefe is our director of sound design. Our staff includes Jeremy Bloom, W. Harry Fortuna, David Gable, Maria Paz Gutierrez, Sindhu Naina Sambandhan, Matt Kielty, Mona Margot-
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