The phrase ‘hookworms may help prevent diabetes’ might not be something people want to hear, but a pioneering trial suggests it might be true.
In a study that will make many toes curl, volunteers were deliberately infected with up to 40 hookworm (Necator americanus) larvae. After two years, they showed reduced insulin resistance and lower body mass, both of which lower the risk of developing type 2 diabetes.
The trial, led by scientists from James Cook university in Australia, is the first of its kind.
The beneficial effects of a hookworm infestation has long been theorised.
‘Parasitic helminths (worms) co-evolved with humans and remain endemic in regions of the world with less metabolic and inflammatory diseases,’ write the authors.
‘Emerging evidence supports the hypothesis that eradicating worms from industrialised regions may have partly contributed to the increased prevalence of immune-mediated diseases such as type 2 diabetes.’
In addition, deworming studies have provided further evidence, finding that individuals who were previously infected suffered a rise in insulin resistance after the worms were removed.
Hookworms make their way through the digestive tract and, as the name suggests, use their hook-like head to latch on to the intestinal walls.
For the latest study, published in Nature Communications, 40 adults at risk of developing type 2 diabetes due to waist circumference and increased insulin resistance were selected.
The participants, both male and female, were divided into three groups. One, the placebo group, were not given any worms. A second group was inoculated with 20 worm larvae, and the third with 40 larvae.
The initial aim of the trial was to determine the safety of hookworm treatment, and while 44% of hookworm-treated participants experienced gastrointestinal symptoms, the drop out rate was roughly the same across all groups. Overall, the treatment was deemed safe.
In addition, after two years, those treated with hookworms were found to have lower insulin resistance compared to an increase in the placebo group. Those treated with hookworms also lost more body mass, on average around 5kg.
Interestingly, a higher worm load did not result in better results, with those who received 20 hookworms showing a bigger decrease in insulin resistance than those who received 40.
Overall, the changes to insulin resistance were both clinically and statistically significant.
How the worms worked their magic however is still yet to be discovered, but the James Cook team is planning further, large-scale studies to better understand the mechanism.
What is clear is that they are highly effective.
So effective in fact, all but one of the study participants chose to keep their hookworms at the end of the trial.
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