Loss of efficacy does not equate to loss of helminths

”I have lost my worms because of <insert any one of your choices here>, my symptoms came back after I ate <insert name of dish here>.

There have developed some myths online regarding the loss of helminth populations, particularly hookworm, due to various foods, herbal remedies, antibiotics, etc. I have read that pumpkin seeds, pineapple, coconut milk or oil, fennel, cummin, tumeric, etc., etc., all “kill hookworms”.

One major example of this type of myth, and it seems a universally accepted example, was created by me. Sorry about that.

Sorry about that.

The fact is that none of these things kills hookworm or whipworms, as a simple thought experiment, or a simple experiment if that won’t satisfy you will demonstrate.

If coconut milk or oil, both staples of the diet in SE Asia, killed either hookworms or whipworms this purported property would have been identified long ago. If they, see list above, they would be used as folk remedies in places where either hookworm and whipworm are endemic. Because of poverty levels that mean no one owns or has access to either toilets or shoes, are public health issues. Having been identified long ago there would have been no market for antihelminthic drugs, and neither Albendazole nor Mebendazole would exist.

The observation of loss of efficacy is trustworthy, but the conclusion that one has therefore lost one’s worm population is not.

If you do an experiment on yourself while enjoying remission or substantial health benefits due to helminthic therapy and you drink or eat one of these things purported to kill helminths in isolation, and within 24 hours you see a return of symptoms you can only conclude you have lost efficacy.

However, we are not aware that anyone has done even this to test the idea that coconut oil or coconut milk, Substance A in this case, alone is responsible. There is a great deal more in all the SE Asian dishes we have eaten than coconut milk or oil alone.

For one to be sure that Substance A had caused the extermination of your helminth population, something distinct from a temporary or permanent loss of efficacy, the following would have to be done:

Having a confirmed population of helminths via stool test* one would have to take in isolation, or to ingest, Substance A, and;

Conduct regular stool tests or some other confirming test to prove ova production had stopped for the next two or three weeks, or;

Having ingested Substance A, collect all of the subject’s faeces for the next two or three days and to examine every particle of it to identify dead helminths in the subjects stool.

Even then it may be the effect of dead helminths, however unlikely it may be or seem, is the result of some other dietary or environmental factor.

A one off stool test looking for ova is insufficient. We know that some drugs suppress ova production, without killing worms, for weeks.

How was it decided that coconut milk, part of a meal with dozens of ingredients, was the culprit?

To decide that one of many constituents of what you eat in a day or two, and that it alone is the cause is just one issue that is problematic with the line of reasoning that coconut milk, Substance A, or coconut oil kills helminths.

The jump from loss of efficacy to assuming that this necessarily equates to the extermination of one’s helminth population is another.

Antibiotics (ABx) are an example that illustrates the problems with thinking coconut anything kills helminths, even if one demonstrates it causes loss of efficacy.

When a subject with an active helminth infection takes antibiotics the effect on helminths are well documented in parasitology texts. Ova production drops substantially for at least two weeks after completing the course of antibiotics. We have also observed in many instances a loss of efficacy associated with antibiotic use. Ova production drops to such an extent that the standard advice is that no parasite and ova test (microscopic examination of a stool sample looking for worm eggs) is reliable until two weeks after the subject has completed the course of antibiotics.

From this, I deduce two things.

A. That ova production is subdued for at least two weeks after taking antibiotics, and that therefore at least some helminths are affected by antibiotics, whether directly or indirectly being unknown.

B. Antibiotics do not kill helminths.

As implied many times to this point, people often erroneously equate a loss of efficacy with the death of their helminths.

Additionally, to determine that one amongst the many things you eat in a day or a week requires more than it is out of the ordinary, and therefore the culprit if you do experience a die off of your helminths. Who is to say it is not the result of some combination of foods or dietary items?

Loss of efficacy rarely in my experience means the death of the helminths.

To illustrate how powerful the act of writing something down in public, on the internet is, I shall here admit that it is a fiction that nitrous oxide kills hookworm. As well that I am responsible for that fiction. I am going to predict as well that making this admission will make not a whit of difference to the widespread belief that this is so.

My wife’s loss of efficacy in 2008 after eating whipped cream, all those years ago, which at the time we assumed meant the death of her hookworm population, is not borne out by experimentation.

I have tested it by inhaling a lot of nitrous oxide over the course of an hour, there is almost no limit to the lengths I am willing to go in the interest of science, and I lost zero hookworms and zero whipworms as a result.

I did get a headache, and I did giggle a lot.

Sorry, but Nitrous Oxide, laughing gas, does not kill hookworms.

So why would one of the breakdown products of the digestion of either coconut oil or coconut milk harm helminths?

Neither hookworms nor whipworms feed on your intestinal contents; they feed on us. Digestion is a process in which a large variety of large and small molecules are broken down into a small variety of smaller ones.

Further enzymatic degradation by the liver starts immediately of many of the products of digestion. That process is how the body can deal with what is an enormous variety of exotic molecules that we routinely take as drugs or eat as food additives.

So if you experience a loss of efficacy don’t assume it means your helminths are dead. Don’t attribute that loss of benefits to anything without very clear evidence that it is a particular thing amongst the many you ate, inhaled, etc., in the previous few days, or weeks.

Use common sense, think about the areas the food comes from and whether helminths are a public health problem in those areas.

Remember that to harm your helminths, which feed on you not what you eat, what you eat has to result in a product of digestion harmful to helminths, but not to you.

Think about whether it is possible to isolate the food as the only possible element in what you have eaten, drank or inhaled, etc., in the period of days before your loss of efficacy with absolute certainty.

Everyone believes and will continue to believe that nitrous oxide kills helminths, that is my fault. Nitrous oxide is something we have not encountered as a species until relatively recently. It is something that is not broken down by digestion, and that would seem on the face of it to be a reasonable way to kill even primitive organisms through disruption of nerve action.

If nitrous oxide does not kill helminths then how likely is it that pineapple, pumpkin seeds, or whatever it is you are eating will kill helminths?