Diabetes and Metabolic Disorders: Are Helminths a Solution?

According to the CDC, about 10% of the United States’ population now has diabetes, and 90-95% of those have type 2.[i]  That is tens of millions of people in this country alone, let alone world-wide.  I need you to be sitting when I tell you the world-wide rate, according to the World Health Organization: “The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.”[ii]  And that is the most recent number, and it was from 6 years ago.

I’m brooding this morning about it because  yesterday I read a paper about the mechanism of action of helminths in alleviating diabetes symptoms:  “We postulated that helminth infections act by modulating the pro-inflammatory cytokine and chemokine milieu that is characteristic of T2DM [type 2 diabetes mellitus (official name)].”[iii]  To test their hypothesis they measured blood levels of pro-inflammatory chemicals in 60 people with diabetes who already had helminths (Strongyloides stercoralis) on board…and then measured these same chemicals 6 months after giving them anti-helminth drugs. They compared them to 58 helminth-free individuals who did not have helminths.

Those with helminths had “significantly diminished levels” of all pro-inflammatory chemicals measured, and to no one’s surprise, killing off their helminths resulted in vastly increased levels.

3 key points from their discussion section:

1. The authors point that helminths’ anti-inflammatory effect (boosting of regulatory cytokines, which modulate inflammation) is already well-established in metabolic diseases:  “…regulatory pathways induced by chronic helminth infections have been associated with reduced insulin resistance and a lower prevalence of metabolic syndrome and T2DM, suggesting that helminth-mediated immunomodulation affords a protective effect against metabolic diseases.”
2. Infection with this particular helminth, Schistosoma, is inversely related to the development of metabolic syndrome and diabetes (that is, as infection rates go up, the rates of the diseases go down…and vice versa), treating people with anti-helminth medicines causes the reverse: kill the helminths and rates of these metabolic disorders go up.
3. Interestingly, while rates of the inflammatory chemicals rose dramatically once helminths were killed, they did not go as high as seen in those individuals who did not have helminths. The authors postulate that this because the  6 months  of the study may not have been enough time for inflammatory levels to fully get back to their disastrous normal.  This is a really important point:  it takes months to a year (or more) for helminths to reach their full anti-inflammatory effect, as research has shown and likely then, it takes months for the system to return to its pro-inflammatory state once the helminths are gone.

The conclusion:  “…our study offers novel insights into the immunological interactions between helminth infections and metabolic disorders…” and that helminth infection, “…could offer novel therapeutic approaches to treating inflammatory metabolic diseases.”

By the way, you’ll note that helminths did not cure the Type 2 diabetes.  Obviously, other steps are still necessary, like weight-loss and a healthy diet.  Also, the number and type of helminths were not controlled in this study.  These people were colonized, yes, but who knows by  how many organisms, how long they’d had the organisms, and perhaps most importantly – whether this particular kind of helminth is optimal in treating the disease.

You do have to wonder, do you not:  how much worse must things get before the medical community acknowledges that we desperately need more research into the optimal ways of using an apparently benign treatment that already exists in nature, to help the millions and millions of people suffering in the world?

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[i] https://www.cdc.gov/diabetes/basics/type2.html

[ii] https://www.who.int/news-room/fact-sheets/detail/diabetes

[iii] Rajamanickam A, Munisankar S, Dolla C, Menon PA, Thiruvengadam K, Nutman TB, et al. (2020) Helminth infection modulates systemic proinflammatory cytokines and chemokines implicated in type 2 diabetes mellitus pathogenesis. PLoS Negl Trop Dis 14(3): e0008101. https://doi.org/10.1371/journal.pntd.0008101