Bye bye Guinea worm

When I took my parasitology course in medical school I was exposed for the first time to all the loathsome diseases that are unheard of here but are a part of daily life in other parts of the world. Here people go nuts and rush to the emergency room if they find pin worms in their kid’s stool; there having a Loa loa worm creep across your eye is a common occurrence and only a minor bother.

I was fascinated with my study of liver flukes, roundworms, tapeworms and all the other parasites afflicting primarily those in tropical areas. The most vile yet amazing of these creatures was to me Dracunculus medinensis, the Guinea worm. This parasite causes untold misery to those it afflicts, and is now, as this BBC piece relates, on its way to extinction. For people living in areas the Guinea worm infests, I’m sure this is wonderful news.

What the BBC neglected to mention is that the eradication of the Guinea worm has been effected in large measure by none other than our former president, Jimmy Carter. Carter, in my opinion, wasn’t much of a president, but he has been a terrific ex-president when he avoids politics and sticks to humanitarian issues. This Carter Center he and his wife founded has been instrumental in educating people in areas where the Guinea worm is common to take the needed steps to intervene in the parasite’s life cycle and disrupt its ability to reproduce. The BBC reports:

A tropical worm disease that has plagued people since ancient times could be eradicated in less than two years, experts predict.

The World Health Organisation said Guinea worm disease, or dracunculiasis, now only affects around 25,000 people in nine countries.

To have this worm beaten back to only the point at which it affects only 25,000 people is a stupendous achievement. I broke out my old med school parasitology text, which was published in 1975, and found that at that time there were an estimated 48 million people infected with the Guinea worm. From 48 million to 25,000 in about thirty years is a real triumph.

The thing that intrigued me the most about the Guinea worm was its inbred ability to do what it needed to do to reproduce itself. As anyone who has read much of my writing knows, I’m driven by the idea that the best diet for man today is the one he cut his evolutionary teeth on. The forces of natural selection mold our genome in ways that we are barely starting to even think about. Our genome not only responds to the foods we eat by turning on or off particular genes, it affects our thinking and emotions as well. Nowhere is this genomic force more well demonstrated than in the Guinea worm.

Water flea

Water flea

Dracunculus medineses is a simple creature in terms of biological complexity with a less than primitive brain. Yet it is driven by incomprehensible forces to do what it
needs to do to propagate. It starts its life as a larva wriggling in the water where it is eaten by a water flea. No water flea meal ingestion — the cycle ends. Once in the flea the larva coils itself tightly and becomes inactive. If the flea dies, so does the larva. But if the flea is consumed by a person drinking the water, the larva gets its next big break. The stomach acid dissolves the flea, but not the larva, which makes its way to the small intestine, then through the wall of the small intestine into the body cavity. Over the next year the female finds and mates with a male Guinea worm larva. The male dies and is absorbed into the body of the female. The impregnated female goes through a growth spurt that ends up with her being an adult worm from two or three feet long and about as big around as a piece of spaghetti. Here’s where it gets interesting.

Up to this point the human host of this worm has no symptoms and hasn’t a clue as to what’s about to happen. The pregnant female begins to migrate toward the victim’s feet. How does it know which way that is? It’s a mystery. Once the worm reaches its destination at the under surface of the skin of the foot or ankle it releases a toxic liquid that causes a blister on the surface of the skin. The blister and the toxic liquid that cause it are extremely painful causing an intense, fiery, burning sensation. The person experiencing this torture is driven to submerge the affected foot into water to help reduce the pain. As soon as the foot goes into the water, the female Guinea worm, with uterus poked out the top of the blister, releases thousands of new larva into the water and the cycle starts again.

Once the female has surfaced and released her larva, she can be seen. The age-old dracunculus.jpgmethod of treatment at this point is to wrap the emerging worm around a stick of matchstick diameter and slowly, very slowly, roll the worm around the stick. It takes several weeks to fully extract the worm. The extraction must be done with extreme care because if the worm breaks during the process a severe inflammatory reaction takes place causing disabling pain and, in some cases, even death.

The worst part of this ordeal is that if you’ve got one Guinea worm, you’ve probably got another ready to erupt at anytime.

By teaching people in Guinea worm infested areas to at least strain their drinking water to remove the water fleas, the life cycle is disrupted. The Carter Center is educating people to do that and to avoid standing in water when the blisters erupt. If the female can’t eject her larvae into the water, the life cycle also comes to a halt.

The take home message of this story is to be aware of urges and drives to eat. If the forces of nature can drive such a simple-brained, primitive creature as the Guinea worm to do all the things it needs to do to reproduce, imagine how strongly these forces work on us infinitely more complex creatures all the time. If a man with his foot on fire from an emerging worm can be trained to go against all his natural inclinations and not plunge his foot in the water, we can be trained not to succumb to our nature-driven urges to go face down in the carbs.

Now, the real reason I wrote this post: I have to expiate for my own sins. My wife bought a box of chocolate candies from a kid trying to raise money for something. She brought them home and put them in a drawer (why she didn’t just give the kid five bucks and say ‘keep the candy’ I don’t know). They’ve been in the same drawer, one in which I almost never look, for several months. Last night MD made ribs for dinner, which I ate along with a few slices of tomato. I felt full and content. Then for whatever reason, the knowledge that those candies were there began to prey on me. Why last night? why not three months ago or anytime in between? I don’t know. It must be one of those drives like the one that drives the Guinea worm to the feet of its victim instead of the hands.

As Hamlet said:

To hold, as ’twere, the mirror up to nature.

Whatever the reason, I opened the box and threw five or six of those suckers back as fast as I could. A paragon of low-carb virtue I was not.

Of course, I felt like crap afterward. Not emotionally, but physically. God only knows how high my blood sugar went. I like to think I’m more complex than a Guinea worm, able to overcome and out think urges installed by my genome, but last night I wasn’t. And I have no one to blame but my genes…and my wife!

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15 thoughts on “Bye bye Guinea worm

  1. Mike, I have a friend, 59, who has been a Type II diabetic for several years. He has gotten terrific advice from his doctor here in south central Connecticut. Over several years, this man, who was very overweight, has followed a “no white food, no sugar” diet to get his weight down and bring his sugar into line. He is approaching the A1C under 7 mark, and his doctor is thrilled with his progress.

    My friend tells me that every once in a while he wants to have something sweet. I think his doctor was wise to counsel him in such a way that he won’t feel deprived. His doctor said that if every few weeks he wants to have a candy bar, go ahead and have it, that his blood sugar would only rise for that episode, and not harm his progress with his A1C.

    In my friend’s case it seems to work very well, for, as I said, his progress in weight loss and sugar normalization is excellent. So maybe you can have that chocolate once in a while, without feeling bad about it. Of course, I’m not sure everyone could, because there are those of us who get “set off” and can’t put the genie back in the bottle. For those people, having a candy bar once a month might be a recipe for disaster.

    Hi Gary–

    Thanks for trying to make me feel better.  It was good for my taste buds for a couple of minutes and bad for my psyche for, let’s see, about 15 hours now.

    I do believe that people that crave something sweet can do okay with dark chocolate made with real chocolate and a little sugar.  My debauch was with the full-octane, high trans fat, high-fructose corn syrup variety, thus the self flagellation. 

    Cheers–

    MRE 

  2. p.s. My friend’s doctor also mentioned that if he kept up the good work, he might soon be able to come off metformin! I should also mention that my friend walks two miles/daily about five times a week.

    Hmmm.  Maybe I should walk about 20 miles today. 

  3. A few weeks ago, in the check-out line at the grocery store, I had a hearty laugh at the sight of the box of candy bars being sold to raise money for diabetes research.

    Hi Alex–

    I’m not surprised. Take a look at an early post of mine on the subject.

    Cheers–

    MRE

  4. Oh, gross! Next time you cheat, Dr Eades, you could just say so. 😉

    I just adopted a dog with heartworms and I’m totally parasitic-wormed out.

    Hi Kristine–

    Have you tried to remove the heart worms by wrapping them around a stick and pulling gently?

    Cheers–

    MRE 

  5. I don’t think you should beat yourself up about it as long as you don’t do it more than a few times every year. I have tried the dark chocolate with sugar and find it doesn’t do the same thing for my tastebuds as milk chocolate with nougat. Luckily for me, I don’t crave it, I can pass it by. I enjoy a good Swiss chocolate bar a couple times a year. I don’t beat myself up for it. Why should I? (I beat myself up for plenty of other things!)

    Hi Gary–

    Maybe that’s the difference.  I don’t usually beat myself up, unless, of course, I chunk an easy little chip shot in golf.  Then I do plenty of beating as I wallow in self loathing.  But other than that I’m pretty easy on myself.  Except when I commit a gross dietary violation, one that I’ve harped on others not to commit, then I turn on myself like a mad dog.

    Cheers–

    MRE 

  6. That’s a hell of a post. Everything a reader could possibly want is in there and delivered in the unmistakable Eadesian fashion. (I could pick your writing out in a double-blind study anytime.) And your comment responses are almost as good — “other than that I’m pretty easy on myself”. Boy am I having a great time reading along or what? Sho is fun, sho is.

    Hi James–

    Thanks for the kind words about the blog. For others who are reading the answers to these comments: This James is one of my best golfing buddies. As such, he has witnessed my descent into self loathing more than once. In fact, he has even piled on.

    Cheers–

    M

  7. Oh golly, my worst nightmare, parasites. I had to put a big sticky over that picture just so I could read the post without gagging. Now I just might have to go eat some chocolate to get my skin to stop crawling and twitching at the mere thought of something coming out of my foot…

    Lindt 85% cocoa is pretty good if you can stand chocolate that’s just this side of bitter.

    You gotta admit, though, that the Guinea worm has a fascinating history.  And I love chocolate that is almost any side of bitter.

    Cheers–

    MRE 

  8. Cheer up Dr. Mike cause I fell face down into a pizza last night. The only redeeming value was the bacon, spinach, feta and mozzarella cheese’s and onions that were on top. Back to my world-famous paprika chicken today which I made in a slow cooker yesterday. It happens but shame on you keeping those chocolates in your house and for that long. Whenever I have a sweet craving I stock the Werther’s Original (no sugar or aspartame added) hard candies around the house and office. They do contain sugar alcohols but not enough to do any serious damage in small quantities.

    But let’s face it, you’d have to be a machine to be able to resist the steady, day-to-day, hour-to-hour, minute-to-minute onslaught of sugar temptations.

    I am a machine, I am a machine, I am a machine… 

  9. Hmmmm…..

    If the Guinea Worm were cute and cuddly, do you think Peta would be outraged by this ‘travesty’?

    I think we should bring it to their attention.  Before you know it we could be back to 48 million cases per year.

    Cheers–

    MRE 

  10. I’m living with my parents while having a house built, so I eat most dinners and Sunday breakfasts with them. I usually just limit myself or pass altogether on anything high-carb (They probably wouldn’t change their eating habits for anything short of a hospital stay, and even then their Dr. would probably tell them to stay on a low-fat, high-carb diet).

    I’d been getting ‘back on track’ after a short trip, and had been at nearly 0 carbs for most of the preceding week when we had Blueberry pancakes with real maple syrup for breakfast on Sunday. That much sugar kept me practically buzzing until 11:00 that night, and then I had to force myself to go to bed!

    How long does it take your system to get ‘back on track’ after a massive sugar spike like that? Is there anything that can hasten it, like fasting entirely, or loading up on more fats and proteins?

    It doesn’t take too long to get back in the pink, usually a day at most.  Whenever I indulge in a sugar blowout I fast or quickly return to my normal very low-carb diet. 

    Cheers–

    MRE 

  11. That sounds even more unpleasant than the cosmic pizza grease! And Dr. E, I think it’s okay that you cheated once. I cheat now and again as well and as long as it’s the exception, not the rule, it’s nothing to get riled over (as if I really need to tell you that =).

    Scott

    I don’t mind cheating from time to time; it’s the particular way I did it then that annoys me.

    Cheers–

    MRE 

  12. My confession – I had a piece of chocolate raspberry cake Saturday night – the real stuff. It was Weight Watchers (low-fat) and small, but real sugar and white flour.

    Better expiate by writing a long post on parasites.

    Cheers–

    MRE 

  13. I heard that you could pick these worms up by walking bare foot on a Tahiti beach. Is this a myth or some other vile parasite?
    cheers
    Lynne

    Hi Lynne–

    It’s not these worms.  To get these you’ve got to drink the water with the infected snails.

    Cheers–

    MRE 

  14. Dear Dr.
    I am a Turkish helmintholog. Nowadays I am writing a Zoonosis Book with medical and veterinary scientist in Turkish language. So I want to use your D. medinensis figures in the your web site. I would appreciate if you give me permission.
    Sincerely Yours.

    Prof.Dr. Sinasi UMUR
    Ondokuz Mayıs Univ. Faculty of Veterinary Medicine
    Department of Parasitology
    Samsun- Turkey
    E mail: sumur@omu.edu.tr

    Please feel free to use any of the photos you like.

    Cheers–

    MRE

  15. Hi Dr. Eades,

    Eeewww on the Guinea worm. I’ll agree with you on the humanitarian Jimmy Carter. On the political ex-Presidenting, however, I’ll admit I’d like to see him admitted to a very nice guarded retirement home with no access to pens, paper, a telephone, or a computer.

    Thanks for all your good work. I’m going to (gently) try to get my father to read your blog. He’s on board with us for the lipid hypothesis, but thinks carbs are the greatest thing since, well, sliced bread. I don’t know what he thinks about the Guinea worm.

    Thanks again.

    low carb

    Maybe you should save the Guinea worm for later in his blog reading timetable.

    Cheers–

    MRE