How Far Would You Go To Get Your Life Back?
Fecal Transplants? If you had a debilitating condition that could be improved by taking stool from a healthy person and transplanting into you, would you do it?
Primitive as it may sound, Fecal Microbiota Transplant (FMT), or fecal transplants as they’re more commonly known, are a potentially lifesaving treatment that many mainstream doctors are ignoring.
It’s a simple procedure: a sample of feces is taken from a healthy human and transplanted (through enema, colonoscopy, or pill) to a donor recipient. There are thousands of different species of bacteria (helpful probiotics) in an ordinary sample of stool, and transplanting the donor stool is thought to repopulate the gut flora faster and more efficiently than other forms of supplemental probiotics.
It has been used (successfully) to treat bacterial infections that antibiotics simply couldn’t treat. The concept of injecting yourself with another person’s fecal matter may be a bit off-putting for many people, but when you’re presented with a life or death situation, a little donor poop doesn’t sound so bad.
Fecal Transplant: Nothing New Here
The concept of fecal transplants has been around for millennia. In the fourth century, Chinese medical literature mentions its use for food poisoning and severe diarrhea. In the 16th century, Chinese physician, herbalist, and acupuncturist, Li Shizhen, used “yellow soup,” a mixture of dry stool and water that was drunk by the patient to treat abdominal diseases. He also used fermented stool and infant feces to treat severe diarrhea, fever, pain, vomiting, and constipation.
According to Dr. Eric Braverman, Director of PATH Medical, “The problem with chronic diarrhea is the loss of nutrients. Food needs a slower transport time to be absorbed and so people become emaciated and weakened because they aren’t absorbing enough calories.”
Veterinarians began using fecal transplant to treat animals in the 17th century. But the first modern use of FMT was in 1958, when a team of surgeons in Colorado successfully treated four human patients who had, what we now know as Clostridium difficile, or C. diff, through fecal transplant via enema.
Since then, many doctors and patients have seen the benefits of FMT, but it’s still far from becoming a mainstream form of treatment, and still relatively unknown to many patients and even physicians.
Fecal Transplant: A Cure For C. Diff?
Fecal transplant is making headway treating previously untreatable infections. When the balance of the microbiota is disrupted, particularly, when good bacteria are lacking, bad bacteria can take over. This is most often caused by antibiotic use. Life threatening diseases such as C. diff and other bacterial infections are much more likely to occur after antibiotic use. Ironically, C. diff is conventionally treated with, you guessed it, antibiotics. It’s no wonder that 20 to 30 percent of patients who are treated with antibiotics experience a recurrence.
Though a few doctors had been performing fecal transplants for a while, evidence supporting FMT as a treatment and cure for C. diff became undeniable in 2013 when a medical trial ended early because monitoring researchers thought it was unethical to withhold FMT from the antibiotics only group. FMT was working more than 90 percent of the time and antibiotics were working only 30 percent of the time. What’s more impressive is that one transplant was enough to cure most patients.
Interestingly, only a few months after this study came out the Food and Drug Administration (FDA) announced that it was classifying FMT as an Investigational New Drug (IND) and a Biologic, and that only physicians already in possession of an approved IND application would be allowed to continue performing fecal transplants. Patients and doctors were in an uproar about the fact that only 20 doctors in the whole country could perform a lifesaving FMT. The FDA reversed its decision and stated that qualified physicians could continue to perform FMT, but only for recurrent C. diff.
Currently, fecal transplant can only be considered in the U.S. as a last ditch effort for people who have recurring C diff infections. That means patients have to go through at least two courses of antibiotics (remember those cause infections, too) before being allowed a natural probiotic transplant.
Fecal Transplants For IBD Patients
Though the 2013 study is specific to C. diff, the fact that FMT worked means there is a possibility that FMT could work for other bacterial infections of the gut as well.
In fact, a 2016 review of 25 studies showed that FMT was a successful treatment for ulcerative colitis, sending roughly 40 percent of patients into remission and 60 percent of patients experiencing clinical response. A 2012 review found that fecal transplants have the potential to be a safe and effective treatment for irritable bowel syndrome (IBS), though evidence is still limited. Another study from 2013 demonstrated that fecal transplant may be a viable treatment for severe Crohn’s disease.
Based on what we know about gut health and how fecal transplant can improve it, it’s reasonable to believe other gastrointestinal diseases may be treated or cured with fecal transplants in the future.
FMT For Non-Gastrointestinal Diseases
Eighty percent of the immune system resides in the gut. That means that if the gut is not at its optimal health, other parts of the body can’t be optimal and can cause all kinds of diseases that seem unrelated to gastrointestinal health. According to Dr. Eric Braverman, “We make more neurotransmitters, especially serotonin, in our stomach more than anywhere else in the body. Our gut is a neuro-immune-endocrine system … Really, our gut determines the rest of our physiology, because our gut is the wall around our internal city.” Our overall health relies heavily on the health of our gut.
Beneficial bacteria is clearly important in keeping the gut from being overrun by bad bacteria and yeast, but dysbiosis, or an imbalance of the gut microbiome, has also been linked to allergies, obesity, diabetes, and cancer. Other studies show that gut health affects the brain and may cause cognitive related illnesses. A 2015 study showed that dysbiosis can cause metabolic diseases, neuropsychiatric disorders, autoimmune diseases, allergic disorders, and tumors.
If lack of gut health can cause non-gastrointestinal diseases, it would make sense that fixing the imbalance (through fecal transplants) could potentially treat or cure these diseases.
According to Dr. Eric Braverman, “The common denominator of all those [illnesses] is neurotransmitters … We have seen great benefits with replacing the flora of the gut because if you have dysfunctional neurotransmitters and the gut is in crisis, it will affect the central nervous system and the enteric nervous system [causing disease].”
Though the medical establishment tends to leave fecal transplant as a last ditch treatment, it may be useful as a first choice therapy. Fecal transplant may even be beneficial in treating common diarrhea. Dr. Braverman continues, “Any type of gastroenteritis caused by bacteria is going to leave a residual bacteria and it will take time for the natural flora to regenerate. When we are able to use natural flora [to treat common diarrhea], we can help speed up their recovery. Once the inflammation is gone, [the patient is] going to absorb food quicker, recover from diarrhea quicker, and regain strength more rapidly.”
Fecal Transplants And Big Pharma
It’s strange that a procedure that works so well is not experiencing more widespread adoption. The biggest obstacle to fecal transplants becoming more widespread is that many physicians distrust the procedure or simply don’t like the idea of it. Some are concerned about potential contamination issues, though none have been shown to occur in any clinical trial. Some physicians, understandably, are not willing to accept a procedure until it is has been tested extensively, no matter what the results have been for the few studies performed. The catch 22 here is that it will take much longer to acquire that kind of research on something that can’t be patented.
According to Wired:
“We already know that fecal transplant works, using a substance that is ubiquitous, abundant, and effectively free. Because of those characteristics, feces are also unpatentable, which effectively guarantees that a pharma company will never become interested in backing fecal-transplant research. But if a feces substitute existed, that could be subject to patent — and we might find that a procedure that can be had for the several hundred dollars it takes to use an endoscopy suite (or much less than that, for the home version), has suddenly become prohibitively priced and available to only a few.”
It turns out, University of Guelph researchers were successful in developing a synthetic stool substitute, called RePOOPulate, which has successfully treated C. diff. The benefit of this synthetic stool is that patients and their doctors won’t have to find donors or pay for testing. Also, synthetic stool, theoretically, is more sanitary, where the bacteria is hand-picked and controlled. Additionally, those that are very squeamish about fecal transplant or unwilling to accept a traditional fecal transplant may still benefit from this treatment. The drawbacks are that traditional fecal transplants may become unattainable or illegal, a once simple and inexpensive procedure could begin to cost much more.
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