WEBVTT - Ep 23 Opening a can of Hookworms 0:00:01.080 --> 0:00:04.320 The smart Alex scientists were not satisfied to declare our 0:00:04.360 --> 0:00:08.320 cow's stumbling symbols of certain death. They declared that hookworms 0:00:08.320 --> 0:00:12.039 were literally gnawing us into the grave. We had never 0:00:12.080 --> 0:00:15.280 heard of Charles Wardour Styles, who had headed a commission 0:00:15.320 --> 0:00:18.760 to eradicate the hookworm, or the writer Walter Hines Page, 0:00:18.760 --> 0:00:23.000 who promoted his efforts, or the Saint Gothard Tunnel in Italy, 0:00:23.040 --> 0:00:25.319 where the dread parasites had caused the death of so 0:00:25.440 --> 0:00:29.240 many of the workers. The crusade against our unseen enemy 0:00:29.280 --> 0:00:32.640 was sprung on us suddenly. In August nineteen twelve, the 0:00:32.680 --> 0:00:35.839 Winston County Journal ran a blood curdling illustration of a 0:00:35.880 --> 0:00:40.760 greatly enlarged female hookworm that resembled a diamond rattlesnake more 0:00:40.800 --> 0:00:43.440 than a worm. We were told the worm had laid 0:00:43.560 --> 0:00:46.680 three thousand eggs a day, but without an explanation of 0:00:46.720 --> 0:00:50.960 who counted them. Alongside the illustration of the voracious monster 0:00:51.400 --> 0:00:54.000 was that of an emaciated boy teetering on the brink 0:00:54.040 --> 0:00:57.240 of the grave. The journal listed times and places when 0:00:57.240 --> 0:01:00.760 a representative of the Rockefeller Sanitary Commission and the Mississippi 0:01:00.800 --> 0:01:03.560 Department of Health would be on hand to gather fecal 0:01:03.600 --> 0:01:07.679 specimens for hookworm tests. I became so frightened at the 0:01:07.720 --> 0:01:11.119 prospect that I was constipated for a week. In the end, 0:01:11.240 --> 0:01:13.520 my test proved negative and I could look forward to 0:01:13.560 --> 0:01:16.880 a healthy existence, provided the scientist did not discover some 0:01:17.000 --> 0:01:18.080 other deadly menace. 0:01:53.480 --> 0:01:55.320 Oh that was really great. 0:01:55.800 --> 0:01:56.800 Isn't that joyous? 0:01:57.200 --> 0:01:58.160 Yeah? 0:01:58.200 --> 0:02:00.040 I love it. 0:02:00.120 --> 0:02:02.840 So terrified I was consummated for a week. I feel 0:02:02.880 --> 0:02:04.080 like I can relate to that. 0:02:04.600 --> 0:02:04.960 I know. 0:02:06.600 --> 0:02:09.480 So that was. That was from a book called My 0:02:09.680 --> 0:02:14.920 Century in History Memoirs by Thomas D. Clark. Hello everyone, 0:02:15.320 --> 0:02:16.120 I'm Aaron. 0:02:15.880 --> 0:02:18.519 Welsh and I'm Erin Almond Updyke and. 0:02:18.400 --> 0:02:21.280 This is this podcast will kill you today. 0:02:21.320 --> 0:02:22.720 We're talking about. 0:02:23.480 --> 0:02:26.200 Worm, which is so exciting. 0:02:26.440 --> 0:02:29.840 It's thrilling. This is our first macro parasite. 0:02:30.160 --> 0:02:32.359 It is. I was thinking like, did we do did 0:02:32.400 --> 0:02:34.040 we know? No, this is it. 0:02:34.200 --> 0:02:35.880 I did the same thing. I was like, well, we 0:02:35.919 --> 0:02:39.000 didn't know. We haven't done any worms. 0:02:40.320 --> 0:02:41.440 And I love worms. 0:02:41.680 --> 0:02:45.560 I know you do. I know they're one of your 0:02:45.560 --> 0:02:46.280 little loves. 0:02:46.560 --> 0:02:48.560 They are one of my little loves, one of my 0:02:48.600 --> 0:02:53.080 many little loves. Okay, So to celebrate the hookworm, the 0:02:53.120 --> 0:02:55.280 glorious hookworm. What are we drinking today? 0:02:55.880 --> 0:02:59.359 Our quarantine today is do poison. 0:02:59.480 --> 0:03:03.880 Oh dw. And it's called that because. 0:03:04.440 --> 0:03:07.200 That was one of its common names. Is that correct? 0:03:07.440 --> 0:03:13.240 It's because you would walk through corning dew, Yeah, and 0:03:13.280 --> 0:03:17.480 then the little larval hookworms would burrow their way into 0:03:17.520 --> 0:03:21.480 you so lovely. So what's in do poison? 0:03:21.720 --> 0:03:26.120 So we've of course got whiskey, preferably bourbon, but you 0:03:26.120 --> 0:03:32.239 could use rye chocolate liqueur, hazelnuts syrup or hazelnut liqueur 0:03:32.440 --> 0:03:35.560 up to you gonuts. Top it with whipped cream, and 0:03:35.640 --> 0:03:40.480 of course dirt in the form of chocolate cookies, and 0:03:40.920 --> 0:03:44.680 the all important vodka soaked gummy worm. 0:03:45.200 --> 0:03:49.280 Yes, booze soaked. 0:03:48.400 --> 0:03:51.360 But don't forget that. We'll post the full recipe for 0:03:51.400 --> 0:03:54.720 our quarantini as well as our non alcoholic Placey Brita, 0:03:55.000 --> 0:03:57.760 on all of our social media channels as well as 0:03:57.800 --> 0:03:58.480 our website. 0:03:59.200 --> 0:04:04.680 That's right cool. Well, now that we've got that really delicious, 0:04:04.720 --> 0:04:10.160 licking drink in our hands, can you tell me about hookworms? 0:04:10.200 --> 0:04:11.480 Tell me all about the biology. 0:04:11.760 --> 0:04:15.080 Absolutely, we'll take a quick break before we get started. 0:04:40.360 --> 0:04:42.680 Just before we dive into the episode, we want to 0:04:42.720 --> 0:04:44.800 let you know that we have a very special treat 0:04:44.839 --> 0:04:47.760 waiting for you at the end. It's a song specifically 0:04:47.760 --> 0:04:51.200 dedicated to parasites, and you're going to love it. So 0:04:51.320 --> 0:04:53.479 if you usually tune out right as we start listing 0:04:53.480 --> 0:04:56.400 our sources, do yourself a favor and keep listening until 0:04:56.400 --> 0:04:57.120 the very end. 0:04:58.320 --> 0:05:04.640 Let's get into the biology. So hookworm. The way that 0:05:04.680 --> 0:05:09.159 you get infected with a hookworm is when, like you said, 0:05:09.600 --> 0:05:14.440 the baby larvae drill their way into your skin. 0:05:15.040 --> 0:05:18.000 It's so cool, it's so cool. 0:05:18.400 --> 0:05:21.679 And this most commonly happens when you're walking barefoot across 0:05:21.720 --> 0:05:25.320 soil or grass or leaf litter that's just teeming with 0:05:25.440 --> 0:05:30.200 tiny baby larval worms. Although it is possible to get 0:05:30.200 --> 0:05:32.280 infected in other parts of your body. So if you're 0:05:32.320 --> 0:05:35.240 digging in the soil, you can get infected in your hands, 0:05:35.600 --> 0:05:38.279 taking a nap in the grass. Why not anywhere in 0:05:38.320 --> 0:05:45.480 your body? Why not? And there are two main species 0:05:45.520 --> 0:05:52.200 of hookworm that infect humans, Nicator americanis and ant Cyclostoma duadinale. 0:05:53.120 --> 0:05:56.000 In the case of ant cyclostoma, you can also get 0:05:56.000 --> 0:05:59.320 infected by ingesting the worms, eating. 0:05:59.040 --> 0:06:02.320 Them, ingesting the larval Yes, the. 0:06:02.360 --> 0:06:06.880 Larval worms, right, yeah, weird, right, But that's all I'm 0:06:06.880 --> 0:06:09.200 gonna say about that, because like, no one talks about it. 0:06:09.200 --> 0:06:12.400 It's just a thing that exists. Okay, So let's go 0:06:12.480 --> 0:06:14.760 over the life cycle of how these worms get to 0:06:14.800 --> 0:06:16.760 the point where they're going to infect you, because it's 0:06:16.800 --> 0:06:18.480 so cool, it's nice. 0:06:18.240 --> 0:06:21.200 So much, but it's one of my favorites. 0:06:21.360 --> 0:06:24.279 Okay. So it all starts, of course, as it almost 0:06:24.279 --> 0:06:29.159 always does, with an egg, just a little unassuming egg chillin' 0:06:29.440 --> 0:06:34.200 in some soil. About twenty four hours after it pops 0:06:34.279 --> 0:06:37.800 into the soil, it'll hatch into a tiny, little L 0:06:37.920 --> 0:06:41.040 one larval worm, which will just scoot along its way 0:06:41.240 --> 0:06:43.760 for like a week until it grows big enough to 0:06:43.880 --> 0:06:47.279 molt again. Now we call it L two. It's not 0:06:47.320 --> 0:06:50.160 gonna hurt anyone. It's just a worm in the soil 0:06:50.480 --> 0:06:54.039 doing wormy things. But then once that gets big and 0:06:54.080 --> 0:06:57.039 strong enough, it'll molt one more time into an L 0:06:57.200 --> 0:07:03.200 three larva. This is strong enough to slither? Do you 0:07:03.200 --> 0:07:07.839 say slither for a worm? Sure to slither its way 0:07:07.920 --> 0:07:11.480 up to the top of some grass or some leaf litter, 0:07:11.800 --> 0:07:14.560 and wait for your foot. 0:07:14.760 --> 0:07:18.280 How big is this L three? 0:07:18.880 --> 0:07:23.640 Very very small? I know how big the adults are, 0:07:23.680 --> 0:07:25.320 and this is smaller than the adult. 0:07:25.560 --> 0:07:27.600 Oh, like, could you see it? 0:07:28.760 --> 0:07:30.400 Yes, you can see it. 0:07:30.440 --> 0:07:33.960 Is it like bigger or smaller than a nymphle tick? 0:07:35.400 --> 0:07:35.840 Bigger? 0:07:36.800 --> 0:07:38.160 Okay? Yeah? 0:07:38.200 --> 0:07:42.920 So the adults are between five and thirteen millimeters. Okay, 0:07:43.200 --> 0:07:45.280 So I don't know exactly how much smaller the L 0:07:45.320 --> 0:07:47.840 three larva are. I didn't see that in my research, 0:07:47.960 --> 0:07:55.320 but I presume they're smaller but definitely still visible as 0:07:55.320 --> 0:07:56.080 far as I can tell. 0:07:56.480 --> 0:07:59.440 How are they growing? Where are they getting the energy 0:07:59.480 --> 0:07:59.800 to grow? 0:08:00.120 --> 0:08:04.400 So they eat microbes in the soil. Oh yeah, so 0:08:04.560 --> 0:08:07.200 when they hatch out of an egg, they'll eat little microbes, 0:08:07.240 --> 0:08:09.280 but they're not hurting anybody. They're just like chill and 0:08:09.280 --> 0:08:13.040 eating microbes, like living in the soil like normal worms. 0:08:13.240 --> 0:08:15.320 But then once they get to this L three stage, 0:08:15.360 --> 0:08:17.840 they're like, now I'm ready for the big kid meal, 0:08:17.960 --> 0:08:22.680 and that is human flesh and blood. So this L 0:08:22.760 --> 0:08:28.520 three larva waiting on top of the grass for you. You 0:08:27.760 --> 0:08:30.920 come along, I don't know, Just out for a walk 0:08:30.960 --> 0:08:33.280 in the woods without your shoes on, because of course 0:08:33.360 --> 0:08:36.560 why not. The grass feels great between your toes, and 0:08:36.640 --> 0:08:41.760 this little larva burrows its way into your foot, goes 0:08:41.840 --> 0:08:47.120 straight for your blood stream, travels through your blood stream 0:08:47.840 --> 0:08:50.560 back to your heart where all your blood goes out 0:08:50.640 --> 0:08:56.439 of your heart and into your lungs. Yep. Once it's 0:08:57.080 --> 0:09:00.520 once it's in the capillaries of your lungs, it'll bust 0:09:00.559 --> 0:09:03.640 its way out into your alveoli, which are the air 0:09:03.720 --> 0:09:08.239 sacks where gas exchange actually happens. So it literally bursts 0:09:08.360 --> 0:09:11.880 out of your blood vessels into the air sacks of 0:09:11.920 --> 0:09:16.480 your lungs, and then it swims its way up your bronchials, 0:09:17.320 --> 0:09:21.880 through your bronchi all the way to your trachea, to 0:09:22.000 --> 0:09:24.920 the top of your trachea, which is called the epiglottis. 0:09:25.240 --> 0:09:28.120 That's the flap that normally makes it so you don't 0:09:28.160 --> 0:09:32.360 swallow your food into your lungs. Maybe gives you a 0:09:32.360 --> 0:09:37.600 little tickle right there and maybe you just a little 0:09:39.360 --> 0:09:42.080 and then it's gonna pop up and over that epiglottis 0:09:42.120 --> 0:09:46.360 and down back into your esophagus. It's gonna travel all 0:09:46.400 --> 0:09:49.320 the way down your esophagus, through your stomach and into 0:09:49.360 --> 0:09:51.920 your small intestine. 0:09:51.520 --> 0:09:53.640 And it's like, hmm, I'm home. 0:09:53.840 --> 0:09:57.439 I'm finally home. It'll molt into an adult worm at 0:09:57.440 --> 0:10:05.640 this stage and then it attaches do you want to 0:10:05.640 --> 0:10:06.439 know how it does this. 0:10:07.240 --> 0:10:08.880 Yeah, it has. 0:10:10.160 --> 0:10:15.760 These two hook things, that's why they're called hookworms, and 0:10:15.800 --> 0:10:19.920 they basically gouge their way into your mucosa or in 0:10:19.960 --> 0:10:22.640 some cases, all the way through to your submucosa, which 0:10:22.679 --> 0:10:27.480 is like through an entire layer of flesh inside of 0:10:27.480 --> 0:10:32.280 your intestine, and they attach in there and they mate, 0:10:32.520 --> 0:10:34.240 So you have to do you do have to have 0:10:34.400 --> 0:10:38.320 at least two worms for them to be successful. They 0:10:38.360 --> 0:10:41.240 mate and then they start laying eggs, and then you 0:10:41.280 --> 0:10:43.960 poop out those eggs. They find their way back to 0:10:44.040 --> 0:10:48.720 the soil and the beautiful cycle of hookworm life begins. Anew, 0:10:50.320 --> 0:10:51.199 isn't that gorgeous? 0:10:51.559 --> 0:10:56.480 It's just I still still even after reading about this 0:10:56.640 --> 0:11:00.920 cycle and being amazed. I'm amazed every single time that 0:11:01.000 --> 0:11:04.319 it will go up through your heart into your lungs. 0:11:04.600 --> 0:11:07.599 You cough it up, you swall, I can't. It's incredible. 0:11:07.679 --> 0:11:12.760 It's so complicated, it's inspiring. Yeah, you should all seek 0:11:12.800 --> 0:11:14.440 to have a what is journey? 0:11:14.480 --> 0:11:16.400 You succeed in a journey such as that. 0:11:21.160 --> 0:11:25.360 So that whole process from initial penetration of your foot 0:11:25.760 --> 0:11:28.840 until egg laying adult takes between five and nine weeks, 0:11:29.200 --> 0:11:33.280 so it's a pretty long process. Okay, so let's talk 0:11:33.280 --> 0:11:35.520 about what's happening in your body. Do you even know 0:11:35.600 --> 0:11:38.640 you're infected? You already mentioned one of the first symptoms 0:11:38.679 --> 0:11:41.120 that you might get, which is groundedge, and so that's 0:11:41.160 --> 0:11:44.240 something that can happen at that initial site of penetration 0:11:44.440 --> 0:11:48.280 where you just have kind of an allergic reaction. You 0:11:48.320 --> 0:11:51.400 get itching, you get redness right from where the site 0:11:51.440 --> 0:11:55.160 where the worm's burrowed in. That's your first hint that 0:11:55.280 --> 0:11:57.080 something might be a miss. 0:11:57.280 --> 0:12:00.240 Okay, anytime that any of you have an itchy foot. 0:12:00.000 --> 0:12:03.679 But it's probably it's probably not a hook. 0:12:06.120 --> 0:12:09.400 But that's what you're all thinking, isn't it. 0:12:09.400 --> 0:12:11.880 It could also be totally asymptomatic, and in a lot 0:12:11.960 --> 0:12:15.319 of cases, hookworm infection is almost entirely asymptomatic, and we'll 0:12:15.320 --> 0:12:18.120 talk about when it is versus when it isn't. So, 0:12:18.840 --> 0:12:21.559 once you get past the grounditch, the worm is just 0:12:21.600 --> 0:12:24.520 swimming through your circulatory system and it makes its way 0:12:24.520 --> 0:12:27.439 to your lungs and since it's bursting out of your 0:12:27.480 --> 0:12:31.360 capillaries and busting its way into your LVLI, you can 0:12:31.400 --> 0:12:36.920 imagine that might cause some damage in your lungs. Yeah, 0:12:36.960 --> 0:12:40.040 so you might get some cough, you might get numinitis, 0:12:40.080 --> 0:12:44.040 which just means inflammation in your lungs, and that's just 0:12:44.080 --> 0:12:47.600 a result of mostly a result directly of the worm's 0:12:47.640 --> 0:12:50.079 causing damage, but it also can be from the immune 0:12:50.120 --> 0:12:53.320 response that you mount in response to the damage that 0:12:53.360 --> 0:12:57.120 the worms cause. And then as they make their way 0:12:57.160 --> 0:13:00.440 into your gut, you might have some minor diarrhea, some 0:13:00.520 --> 0:13:07.440 intestinal upset. But if you just have a few worms, 0:13:08.000 --> 0:13:12.319 you might not ever know it because just a few worms, 0:13:12.760 --> 0:13:15.320 these are small, They're not doing a ton of damage. 0:13:16.440 --> 0:13:20.480 NBD. The last one happens to die and you poop 0:13:20.480 --> 0:13:21.840 it out and you see it in your poop. 0:13:22.880 --> 0:13:25.480 Well, I mean, is that that's going to do you 0:13:25.559 --> 0:13:27.400 some psychological damage? Maybe? You mean? 0:13:28.000 --> 0:13:32.239 Sure? It's sort of like if you see one cockroach, 0:13:32.640 --> 0:13:35.400 you know that there are thousands more in your walls. 0:13:35.760 --> 0:13:36.840 Yeah. 0:13:36.840 --> 0:13:38.880 Is it the same with hookworms and intestinal walls? 0:13:39.200 --> 0:13:41.800 Uh? No, I think if you had thousands of hookworms 0:13:41.840 --> 0:13:43.800 in your walls, you'd know it. 0:13:43.840 --> 0:13:48.640 They'd be tens what's the scale at which which we 0:13:48.640 --> 0:13:49.679 start to see infestation? 0:13:49.800 --> 0:13:54.040 Because let's talk about it. So the problem here is 0:13:54.080 --> 0:13:58.760 that because the worms in your gut can produce if 0:13:58.760 --> 0:14:02.480 we're talking about nicatamorus nine to ten thousand eggs a day. 0:14:03.040 --> 0:14:06.200 If we're talking about an Cyclostoma duodenale, we're up to 0:14:06.320 --> 0:14:08.320 thirty thousand eggs per day. 0:14:08.960 --> 0:14:10.000 So it's incredible. 0:14:10.160 --> 0:14:14.920 It's incredible. And these worms are not reproducing in your body, 0:14:15.000 --> 0:14:19.160 so you're not going to get multiple worms from just 0:14:19.280 --> 0:14:22.000 two worms. They're not going to reproduce adult worms in 0:14:22.080 --> 0:14:26.400 your body. However, if you're being constantly exposed to soil 0:14:26.600 --> 0:14:30.360 that's contaminated with human feces and humans are pooping out 0:14:30.480 --> 0:14:33.680 nine to thirty thousand eggs per day, you can end 0:14:33.800 --> 0:14:39.560 up with an extremely high parasite burden. And the reason 0:14:39.600 --> 0:14:43.080 that that's problematic is because when the adult worms use 0:14:43.120 --> 0:14:48.080 their little hooks and they cut their way into your mucosa, 0:14:48.160 --> 0:14:53.440 they use negative pressure, they contract their esophagus to suck 0:14:53.560 --> 0:15:00.960 out your blood, and they use both their physical sucking 0:15:01.040 --> 0:15:05.720 and biting as well as hydrolytic enzymes to burst open 0:15:06.160 --> 0:15:11.640 your capillaries and arterials, suck out a plug of your 0:15:11.720 --> 0:15:17.480 tissue into their open mouth, anti coagulate the crap out 0:15:17.480 --> 0:15:19.320 of you so that you don't stop bleeding, and then 0:15:19.360 --> 0:15:20.880 they're drinking your blood. 0:15:21.600 --> 0:15:28.000 Oh, boy so, and there are species differences between the 0:15:28.040 --> 0:15:30.680 amount of blood that they take as well. 0:15:30.960 --> 0:15:33.760 Yeah, so the smaller worms which are in the cater 0:15:33.880 --> 0:15:39.920 americanas take between like, they take much less blood than 0:15:40.080 --> 0:15:46.120 ant Cyclostoma do adon alle. Even a douadon alley would 0:15:46.160 --> 0:15:50.120 only take a maximum of about zero point three milliliters 0:15:50.240 --> 0:15:55.480 of blood per day, which isn't a lot, right, that's 0:15:55.600 --> 0:15:59.920 point three mills. That's basically nothing. However, I did some math, 0:16:01.040 --> 0:16:03.520 because you know, whenever we start talking numbers, I'm going 0:16:03.600 --> 0:16:08.440 to do some math. The human body has five liters 0:16:08.480 --> 0:16:14.560 of blood. Okay, on average, your red blood cells reproduce 0:16:14.800 --> 0:16:17.840 in one hundred and twenty days, So we can assume 0:16:18.040 --> 0:16:21.800 that your blood volume replaces itself every one hundred and 0:16:21.880 --> 0:16:27.520 twenty days. So if you back calculate, you're making on average, 0:16:27.880 --> 0:16:32.640 about forty five milliliters of blood every day. That's how 0:16:32.680 --> 0:16:35.600 much new blood your body is producing every day. So 0:16:35.680 --> 0:16:38.600 if you have just one worm and you're losing zero 0:16:38.600 --> 0:16:41.920 point three mills of blood per day, no big deal. 0:16:42.520 --> 0:16:46.600 But once you get to let's say one hundred worms, 0:16:47.200 --> 0:16:51.760 that's thirty mils of blood loss per day. Wow, that's 0:16:51.880 --> 0:16:54.160 almost that's more than half of the blood that you're 0:16:54.160 --> 0:16:55.760 able to make every day. 0:16:55.960 --> 0:17:01.080 That's only one hundred worms. And that's only one hundred worms, right, extreme. 0:17:00.800 --> 0:17:05.520 Yeah, it's not. And so your body, if you are 0:17:05.560 --> 0:17:09.440 losing blood, your body will start to upregulate red blood 0:17:09.440 --> 0:17:12.800 cell production. That's that's what your body does. If something happens, 0:17:12.840 --> 0:17:15.399 it will respond. That's why if you give blood and 0:17:15.440 --> 0:17:18.560 you lose a pint, you don't die immediately. Your body's like, 0:17:18.560 --> 0:17:21.760 no problem, We'll use our iron stores and will make 0:17:21.920 --> 0:17:25.000 new red blood cells faster than we normally would. But 0:17:25.080 --> 0:17:29.280 if you're constantly losing thirty or more mills of blood 0:17:29.359 --> 0:17:33.760 per day, eventually those iron stores run out and you 0:17:33.920 --> 0:17:37.320 can't make new blood. You just can't. You don't have 0:17:37.400 --> 0:17:40.199 the materials in your body to actually do it. So 0:17:40.280 --> 0:17:42.960 the biggest thing that we see in people who have 0:17:43.359 --> 0:17:48.119 high worm burdens is iron deficiency anemia. So that's the 0:17:48.200 --> 0:17:51.960 kind of hallmark sign and so much of the sort 0:17:52.000 --> 0:17:55.800 of downstream effects that we see are all due to 0:17:55.920 --> 0:18:00.840 this iron deficiency anemia that just results from blood law itself. 0:18:01.359 --> 0:18:03.080 Wow. Yeah, And you. 0:18:03.000 --> 0:18:06.280 Can start to see this especially depending on who you're 0:18:06.280 --> 0:18:10.080 talking about. So women, if you are a woman of 0:18:10.119 --> 0:18:14.240 reproductive age who has a uterus, you're probably losing blood 0:18:14.280 --> 0:18:17.399 every month, which means that you're already more susceptible to 0:18:17.440 --> 0:18:21.600 iron deficiency anemia. If you are a child, you don't 0:18:21.600 --> 0:18:24.359 have a full five liters of blood, which means you're 0:18:24.400 --> 0:18:27.880 already more susceptible to iron deficiency anemia because you don't 0:18:27.880 --> 0:18:29.520 have as much blood and you don't have as much 0:18:29.560 --> 0:18:33.880 iron stores. You're just a smaller human. It's actually adults 0:18:33.920 --> 0:18:37.400 who have the highest burden of hookworm, which is totally 0:18:37.400 --> 0:18:39.720 the opposite of most other soil transmitted helmets, where you 0:18:39.800 --> 0:18:42.439 see the highest burden in children. And it's thought that 0:18:42.480 --> 0:18:47.040 this is because hookworms are really good at evating our 0:18:47.080 --> 0:18:49.400 immune system, so while other worms you get a high 0:18:49.400 --> 0:18:51.479 burden and then you can eventually clear them with your 0:18:51.480 --> 0:18:54.840 immune system. Not so. So it's just a linear trend 0:18:55.200 --> 0:18:58.159 where you're exposed over your whole life, and the older 0:18:58.160 --> 0:18:59.479 you get, the more worms you have. 0:19:00.480 --> 0:19:02.400 Oh I see, isn't that crazy? 0:19:02.680 --> 0:19:07.240 Yeah huh so, yeah, that's how you end up with 0:19:07.280 --> 0:19:13.800 iron deficiency anemia. That's the biggest issue with hookworm infection, 0:19:14.960 --> 0:19:17.760 and children especially are at really high risk because when 0:19:17.840 --> 0:19:20.800 children suffer from high burdens of hookworm, and they end 0:19:20.880 --> 0:19:23.800 up with iron deficiency anemia. They can also have growth 0:19:23.840 --> 0:19:28.840 retardation and cognitive impairments which are life long, and so overall, 0:19:29.280 --> 0:19:31.800 you can start to see the effects of iron deficiency 0:19:31.840 --> 0:19:35.920 anemia with as few as forty to one hundred and 0:19:36.000 --> 0:19:39.080 sixty worms. That's the range that I found, and it's 0:19:39.160 --> 0:19:42.840 not uncommon to find people with much much higher worm 0:19:42.880 --> 0:19:45.240 burdens than forty two one hundred and sixty worms. 0:19:45.960 --> 0:19:47.280 Yeah, so. 0:19:49.280 --> 0:19:54.000 That's that's hookworm in a nutshell. The good news about 0:19:54.040 --> 0:19:57.160 it is that it is quite treatable. It usually only 0:19:57.240 --> 0:20:00.520 takes a few doses over a few days of anti 0:20:00.560 --> 0:20:05.880 holme ethics albendazol or another benzimittazol if you're interested in 0:20:06.000 --> 0:20:08.520 what you treat it with, and you can pretty much 0:20:08.600 --> 0:20:11.240 get rid of all of them. However, the biggest problem 0:20:11.359 --> 0:20:14.199 is that if you don't address the sanitation issues that 0:20:14.320 --> 0:20:17.679 often are the cause of hookworm infection, then reinfection is 0:20:18.000 --> 0:20:19.160 almost inevitable. 0:20:20.000 --> 0:20:23.479 Right, So, I have a question that's a little bit 0:20:23.520 --> 0:20:27.760 out there. Okay, you mentioned that hookworms are really good 0:20:27.800 --> 0:20:31.919 at evading your immune system. Do they suppress your immune system? 0:20:32.040 --> 0:20:33.240 That's not my out there question. 0:20:35.480 --> 0:20:39.440 So I don't know if they suppress your immune system directly. 0:20:39.840 --> 0:20:42.600 They do, and there's a lot of interesting evidence that 0:20:42.640 --> 0:20:45.560 they modulate your immune system, so they do have big 0:20:45.600 --> 0:20:49.320 effects on changing the way that your immune system responds 0:20:49.359 --> 0:20:54.119 to them. The interconnectedness between the human immune system and 0:20:54.680 --> 0:20:59.199 parasitic worms is so amazing. It's so cool. 0:20:59.560 --> 0:21:02.879 It is because there are ancient enemies and friends at 0:21:02.880 --> 0:21:07.040 the same time. It's incredible, it's so so interesting. But 0:21:07.200 --> 0:21:10.520 so my out there question is, I remember during my 0:21:10.600 --> 0:21:14.399 masters I ran into many different studies on people self 0:21:14.440 --> 0:21:17.879 treating with hookworms, to treat MS, to treat crones, to 0:21:17.920 --> 0:21:23.680 treat ibs and other sort of autoimmune disorders. What's going 0:21:23.720 --> 0:21:24.080 on there? 0:21:24.160 --> 0:21:26.600 So I was I had all of this in the 0:21:26.640 --> 0:21:28.800 current events section, but we can talk about it. 0:21:28.720 --> 0:21:31.760 Now, Okay. I wasn't sure if I was jumping the gun. 0:21:32.080 --> 0:21:36.399 Yeah, so yeah, So this all stems from this idea 0:21:36.440 --> 0:21:38.920 of what's called the hygiene hypothesis, which I think we've 0:21:39.000 --> 0:21:42.560 talked about before on this I don't remember. 0:21:43.040 --> 0:21:45.639 Let's do a refresher anyway, Okay, So a quick refresher. 0:21:45.640 --> 0:21:48.400 The hygiene hypothesis, which is also sometimes called the old 0:21:48.440 --> 0:21:52.520 friends hypothesis, is this idea that the reason that we 0:21:52.600 --> 0:21:56.760 see such high rates of allergies and autoimmune diseases in 0:21:57.560 --> 0:22:01.399 a lot of wealthy nations is because cause we have 0:22:01.560 --> 0:22:06.040 eliminated all of the diseases that we normally are exposed to, 0:22:06.400 --> 0:22:12.760 especially parasitic worms, which our immune system essentially evolved under 0:22:12.880 --> 0:22:20.440 constant attack in in conjunction with like constantly being exposed 0:22:20.640 --> 0:22:23.920 to things like parasitic worms. And so it's the idea 0:22:23.960 --> 0:22:27.639 that our immune system evolved to respond at a baseline 0:22:27.760 --> 0:22:30.320 level assuming that we were always going to be infected 0:22:30.320 --> 0:22:33.480 with something. When you take all of that away, your 0:22:33.520 --> 0:22:35.800 immune system's like, well, what the heck am I going 0:22:35.880 --> 0:22:39.920 to do? Guess I'll start attacking myself. That's the very 0:22:40.000 --> 0:22:47.320 simplified hygiene hypothesis. So people have suggested purposefully infecting people 0:22:47.359 --> 0:22:52.360 with helmets such as hookworms can help to control autoimmune diseases, 0:22:52.520 --> 0:22:58.639 especially gastrointestinal autoimmune diseases like alterative colitis crones celiac disease, 0:22:59.119 --> 0:23:02.320 and also to help control allergies and other autoimmune diseases 0:23:02.359 --> 0:23:06.040 like you said, like MS. So the basic idea is 0:23:06.040 --> 0:23:08.560 that if you give patients a few worms. Not a 0:23:08.640 --> 0:23:12.199 high burden, because we know that's terrible, but just a 0:23:12.200 --> 0:23:15.000 few they'll attach to the gut like they would normally, 0:23:15.119 --> 0:23:18.760 and it induces a certain amount of inflammation, but it 0:23:18.840 --> 0:23:22.760 also modulates your immune system in ways we don't fully understand, 0:23:23.320 --> 0:23:26.640 and this will then reduce the symptoms of these other 0:23:27.280 --> 0:23:30.119 hyper inflammatory autoimmune type diseases. 0:23:30.680 --> 0:23:34.919 And it seems anecdotally to sometimes work, but what are 0:23:34.960 --> 0:23:35.720 the stats on that. 0:23:35.880 --> 0:23:39.600 So there's a really interesting review article. It came out, 0:23:39.640 --> 0:23:41.919 I believe in twenty fifteen. I'll definitely post it on 0:23:41.960 --> 0:23:47.720 our website. It's very mixed results, leaning towards it doesn't 0:23:47.760 --> 0:23:51.320 seem to be working. Okay, So in animal studies it 0:23:51.600 --> 0:23:56.480 definitely works, but in clinical trials it hasn't been successful. 0:23:56.560 --> 0:23:59.000 And so one of the ideas is that maybe you 0:23:59.080 --> 0:24:02.639 need to have been expos to worms before the onset 0:24:03.040 --> 0:24:06.240 of this hyper inflammatory state, which I thought that's super 0:24:06.280 --> 0:24:09.320 interesting that like maybe once you already have crones you 0:24:09.359 --> 0:24:12.280 cannot heal it with a worm, but maybe if you 0:24:12.320 --> 0:24:14.880 had had worms you would be less likely to get 0:24:14.960 --> 0:24:18.680 crones or something like that. So at this point, there 0:24:18.760 --> 0:24:21.040 isn't really a lot of clinical evidence that it works 0:24:21.160 --> 0:24:24.439 at all, but it is still a cool concept and 0:24:24.480 --> 0:24:27.000 there is definitely still research that's being done on it, 0:24:27.720 --> 0:24:32.240 so ah cool. Yeah. So that's pretty much the biology 0:24:32.280 --> 0:24:37.679 and a little bit of the current research just for fun. So, Aaron, 0:24:37.760 --> 0:24:40.320 how do you get to this point? Where did these 0:24:40.320 --> 0:24:44.040 guys come from? Okay, I'll tell you right after we 0:24:44.160 --> 0:25:06.879 sell you more things. 0:25:07.960 --> 0:25:11.680 Though there have been exceptions, like with leprosy and tuberculosis, 0:25:11.800 --> 0:25:14.840 we've mostly been dealing with pathogens that leave no physical 0:25:14.880 --> 0:25:18.439 trace of infection on bones or in fossil form, so 0:25:18.480 --> 0:25:21.160 our search of the history of a pathogen can't really 0:25:21.160 --> 0:25:24.640 extend much beyond the earliest writings. Of course, we can 0:25:24.680 --> 0:25:28.480