I was thinking about worm dose and efficacy. (Brace yourself; this is
long and convoluted.) If one were to be dosed once with 10 larvae,
then accounting for attrition, there would be perhaps 7 left in the
gut. (And this number may be a high estimate.) Assuming a 50% gender
split, there would be 3 or 4 males. (And there could be 2, 1.) This
Cornell transcript claims the males die off after copulation.
(http://www.cumc.columbia.edu/dept/ps/2007/para/old/transcript_02_pd02.pdf)
Even if they don’t, this paper claims the lifespan, though averaging
3-5 years, is really much shorter than that.
(http://www.jimmunol.org/cgi/content/full/173/4/2699) Would 3 or 4
worms be enough to maintain a steady immunological state? How many
months/years would they live and would there be an average drop off
around the same time? (meaning; do they all die at once?) As
Nottingham is only studying their Crohn’s patients for 6 months, they
will not collect this data, which is unfortunate. (length of
efficacy, worm lifespan, wormcount after x number of months/years,
timing of necessary reinfection, etc.) So we’re on our own…
This study says that adding a population of 50 in two healthy people
who hosted existing hookworms resulted in some old worms dying and new
ones replacing them, with no netted increase in number.
(http://www.ncbi.nlm.nih.gov/pubmed/17035088) So for these two
people, adding worms at a high, one time dose, didn’t result in a
greater population. What the paper doesn’t address is age of the
worm. How many new worms replaced the old? Would one end up with a
mixed age population? That should extend efficacy, assuming the new
ones live longer than the first cohorts. (Some worms would be old
crones…surrounded by fresh whippersnappers.)
It seems like the only choice to maintain a healthy, thriving
population is to redose periodically, with a small enough number not
to illicit enough of an allergic response to expel the new or old
population. What is the number before adding becomes displacing? If
one started with 10, was left with 5, added 15, they merely displaced,
then one is left with 5 again. Would adding 2 be more effective?
And then I wonder how much of the acquisition of new larvae is part of
the immunological puzzle. If there is an additional, temporary
benefit from each subsequent infection, ( the bounce, or the “hookworm
high”) then perhaps maintaining both the immunological and
psychological health of the human and an effective worm burden is
based on the constant periodic addition of small numbers of worms.
Which means the patients who get one dose only are incomparable to the
ones who get 3 doses, who are incomparable to Jasper, for example,
who’s had multiple tiny doses. Perhaps his efficacy would have
waned if a small, steady population wasn’t supplied?
If there is a psychological component to small reinfections, along
with a temporary immunological benefit, perhaps man evolved to have
this periodically. Sort of a natural antidepressant to go with the
immune regulation. This study finds antidepressant qualities in the
soil bacteria itself
(http://www.medicalnewstoday.com/articles/66840.php), showing even
greater depth to the whole hygiene hypothesis. Depression as a
consequence of our sterility. We may need not only the worms, but the
soil they came from.
Which means trying to recreate the natural state by supplying one
aspect of it; the worms, in an unnatural dose (one time, a great
number) and removing everything else may not work. What is the
natural number and frequency of infection in the wild for a healthy
adult anyway?
This really argues against a one time inoculation, at least based on
the theory that the worms’ benefit will last as long as they are
alive. Yet it also argues against multiple inoculation therapy, as
that might cause one to end up with the same amount as one began with,
or less. It seems the only way to recreate the natural state is to
add 1 or 2 worms at a time.
There are no answers to any of these questions yet…Will we die
before we learn how to properly live?
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