Obesity, Metabolic Syndrome and Diabetes: Helminths May Hold the Answers

I found a bunch of new research on helminths and will, over the next month or so, make my way through the papers.  I wanted to share first an article just published by researchers in Australia (where some of the best hookworm (Necator americanus) research is currently taking place, describing a new clinical study they will be conducting.[i]  I have most of the first page highlighted, to share with, as it describes their justification for the study.  It’s incredibly compelling – especially as you know that the obesity epidemic is a topic of particular interest to me. (As I have said a million times before – it’s NOT as simple as “eat less”!)

Here are some of the high points of the “why we need to do this trial.

I warn you:  this is truly shocking.  Take a deep breathe before reading.

1. Since 1980, the number of people in the world who are overweight (including children) has increased exponentially, and current estimates have us now at 2.1 billion people.
2. Obesity is now considered a pandemic. (Because we needed another…)
3. Obesity is the 4^th leading cause of death in the world today.
4. Abdominal obesity is the main cause of metabolic syndrome, which includes insulin resistance, hypertension and dyslipidemia (i.e. high cholesterol, etc.). Metabolic syndrome itself increases the risk of cancer, cardiovascular disease, and type 2 diabetes (T2DM).
5. Sit down before you read this one: ¼ of the world’s population now suffers from metabolic syndrome.  A QUARTER OF THE WORLD’S POPULATION.  I read that sentence in the paper 3x before I could grasp it.
6. In Australia, 35.8% of the population suffers from metabolic syndrome. Over 1/3 of their population.  Good heavens.
7. The reasons for this are unclear but the increased consumption of a “western diet” and sedentary lifestyles certainly play a factor.
8. How about this one? 8% of adults in the world now have full on type 2 diabetes.  This is about 425 million people.
9. Reasons for this massive increase in diabetes: chronic inflammation of course.  And this inflammation and disease also puts these individuals at high risk for vascular dysfunction, including heart attacks, artery disease (i.e. stroke, etc.), diabetic neuropathy (which can end up causing the loss of limbs), and retinopathy (eye disease that can lead to blindness).

So, why  use helminths to try to treat this global disaster?

1. “…the increasing incidence and prevalence of inflammatory diseases such as T2DM, inflammatory bowel disease, and asthma in developed countries offset the successful reduction in parasite-related diseases following helminth eradication efforts.”  And don’t forget allergies, autism, depression, heart disease, cancer, other autoimmune diseases, etc. etc. etc.  In other words:  the staggering increase in chronic inflammatory illnesses overwhelms the savings in terms of diseases associated with having helminths on board.
2. Many studies have corroborated this association: as helminth exposure goes down, chronic inflammatory diseases go up.  One study in Australia, as just one example, showed this inverse relationship between T2DM and infection with a helminth called Strongloides stercoralis, “…indicating a possible protective relationship.”
3. A meta-analysis then conducted supported this finding, including the reduction of cardiovascular disease and dyslipidemia.
4. Another important recent study also provided support of this (i.e. helminths protect against T2DM and complications from it: “…a recent study in a helminth-endemic region of Indonesia showed that antihelminthic drug treatment of people with an active helminth infection significantly raised HOMA-1R values [a blood test showing insulin resistance] and insulin resistance, suggesting that the removal of worms was causally associated with worsened glycemic control.”
5. I won’t go in to the many animal studies supporting the association of glycemic control and helminth colonization. I  have discussed this somewhat before on my blog:  check this post out.
6. Previous research has shown that NA is safe, well tolerated and highly anti-inflammatory, suggesting that these worms can be successfully used to treat obesity and T2DM. We also, of course, know that they positively modulate the bacterial microbiome.
7. Thus, we need a human study establishing them as a treatment.

This study will be conducted on 45 obese, but otherwise healthy men and women, aged 18-50, over 24 months.  It will be randomized, double-blind, placebo-controlled so the gold-standard of human clinical trials.  The researchers will be measuring body fat composition, inflammatory status, immune response, metabolic status (i.e. insulin sensitivity, etc.), microbiome analysis.

They conclude with 2 sentences I must share:

1. “The steeply rising cost of healthcare associated with overweight and obesity-induced metabolic diseases, including T2DM,in Australia and increasing cases of obesity and T2DM in children of obese or overweight mothers urgently calls for new approaches in preventing disease progression.”
2. “Recent research has highlights the complex interplay between the organisms that comprise our intestinal microbiota (commensal bacteria), macrobiota (helminths), and the host mucosal immune response.  Consequently, the absence of either micro- or macrobiota may disturb homeostasis in the host and predispose the immune system to a more pro-inflammatory response.”

Well, everyone…you have to admit that I said it first.  Ha!  (The Biome Buzz is so where it’s at.  Just one more example, here, because I’ve earned bragging rights.)     :- )

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[i] Pierce, D, et. al. Safety and tolerability of experimental hookworm infection in humans with metabolic disease:  study protocol for a phase 1b randomized controlled clinical trial.  BMS Endocrine Disorders. 2019;19:136.   https://doi.org/10.1186/s12902-019-0461-5