Fecal Transplants. Really??
Fecal Transplants. Perhaps you have seen headlines or read about them. You may be curious about what a fecal transplant involves and why on earth anyone would want one, while simultaneously struggling to overcome a deep-seated revulsion over the word “fecal.”
Fecal transplants have been in the news quite a lot recently, hailed as an exciting medical breakthrough for fighting certain diseases and health concerns. Although they might seem somewhat gag-inducing, we at Healthy Gut Bugs are very excited about the promise this crude yet simple procedure holds for treating antibiotic resistant disease, depression, obesity and other medical conditions that are related to microbial imbalances in our gut.
How is Bacteria Related to Health?
We have begun to learn how vitally important the 100 trillion microbes (several pounds worth) that inhabit our bodies are to our physical and mental health. Bacteria, particularly those that call our digestive tracts home, play a critical role in training and supporting our immune systems. They aid in digestion and vitamin synthesis. They produce neurotransmitters than can contribute to mental well-being. Science is starting to show that when an unhealthy mix of microbes develops, it can contribute to digestives disorders, auto-immune disease, allergies and asthma, depression and anxiety and obesity. There even appears to be an association between a disordered microbiome and autism.
What is a Fecal Transplant?
A fecal transplant is a medical procedure that attempts to restore health-promoting bacteria to a person with an unhealthy mix of microbes in their digestive tract (the “microbiome”), in an attempt to cure illness. The first documented fecal transplant in modern medicine occurred in 1958. But, the historical record reveal that traditional Chinese medical practitioners in the 4th Century would grind up poo samples in liquid and feed it to the patients under the name, “yellow soup” to treat food poisoning and severe diarrhea.
A fecal transplant is often considered when important strains of healthy microbes are missing from a sick individual’s digestive tract. Bacterial infection, antibiotics, poor diet, excessive alcohol consumption and chronic stress can each reduce the numbers and variety of health-promoting microbes.
The goal of the fecal transplant is to increase microbial diversity and to restore missing microbes in the large intestine where they perform their disease fighting, health promoting functions. Our feces are packed with microbes – 30% of fecal solid mass is made up of microbes. Meanwhile, those with poor microbial health lack such probiotic bacteria in their intestines. Healthy people produce feces awash with health-promoting bacteria.
To perform a fecal transplant, a medical doctor takes a sample of feces, which contains high quantities of living microbes, from a healthy donor. The donated stool is then mixed in a solution and strained. Since the majority of the gut microbes are found in the large intestine, the donated fecal sample needs to be placed directly into the large intestine. The physician, by means of a colonoscopy, endoscopy, sigmoidoscopy, or even enema, then inserts the strained solution directly into the large intestine of a diseased individual. Voila. Often the patient is under sedation during the procedure.
How Does it Work?
Dr. Colleen Kelly, a doctor at Brown University and the Women’s Medicine Collaborative describes a fecal transplant saying “It’s really almost like an organ transplant.” Kelly continues, “You’re taking this whole community of microorganisms from one person, [and] transplanting them into another person. Then these things … take root, colonize and kind of restore that balance.”
Health-promoting microbes can cure illness in several ways.
Certain microbes are germ fighters. They produce anti-bacterial chemicals that actively kill the disease causing microbes. These chemicals, unlike the wide-spectrum antibiotics that we use in modern medicine that harm helpful as well as harmful microbes, are targeted specifically at disease-causing microbes. This leaves the helpful microbes intact to keep doing their good work.
Increasing the diversity of microbes in the intestinal tract means that the bad guys now have to compete for resources such as food and space in the gut. As the good guys increase in number, the bad guys are pushed back and their numbers fall.
Still other healthy gut bugs play a role in curing disease by stimulating the body’s own immune system to fight back against the disease-causing invaders. They emit chemical signals that the immune system understands, triggering both an immediate disease fighting response by the immune cells as well as telling the body to increase its production of immune cells, thereby increasing their numbers.
Finally, there is a theory now being explored that the human genome itself does not contain all of the genes necessary for optimal functioning of the human immune system. The microbiome in the human body contains ten times more genes than are found in our DNA. Our microbial inhabitants are passed along from mother to child and have co-evolved with us since the beginning of human history for our mutual benefit. Microbiologists are starting to believe our microbiome is almost like another human organ and that some of the microbial genes are as necessary for our health as our own genes are. Increasing the number and diversity of bacteria in a disordered microbiome can perhaps reintroduce missing bacterial genes that our immune system relies on to keep us healthy.
What Conditions Can Be Helped by a Fecal Transplant?
– Antibiotic resistant C. difficile infections.
C. difficile is a bacterial infection caused by the Clostridium difficile bacteria. This dangerous disease is very common among patients who have been hospitalized for other medical reasons and in patients in nursing homes. Toxins the bacteria produce cause extremely serious and sometimes fatal diarrhea.
The number of cases of C. difficile infection has increased dramatically in recent years. The US Federal Centers for Disease Control and Prevention (CDC) reports that the bacteria causes 500,000 illnesses in the United States each year and kills about 29,000 people. It is particularly dangerous for elderly patients.
Relapses are extremely common, with up to 30% of patients experiencing one within several weeks of being treated with Vancomycin, the antibiotic of choice for this disease. A new, highly virulent strain of C. difficile has emerged. At the same time, antibiotic resistance is increasing – our standard tool kit of treatments isn’t working for many patients. Death rates from the disease are going up.
Some medical researchers actually advise against using prolonged courses of antibiotics to treat infections, except when absolutely necessary, as they can kill some of the disease fighting microbes in the immune system, making a patient vulnerable to C. difficile bacteria or other serious illnesses.
Increased hand washing and hygiene practices in medical settings such as hospitals, doctors’ office and nursing homes, where the disease can easily spread from one patient to the next, is the best way to prevent the disease from taking hold. But once antibiotic resistant C. difficile takes hold, treatment options are unlimited. Some patients resort to having part of their colon removed in an attempt to eradicate the infection.
Fecal transplants have been shown to be remarkably effective in ridding patients of this dreaded disease in a very short period of time. Of the 24 fecal transplants performed by the Mayo Clinic in Arizona for this condition since 2011, there was a 100% cure rate. It’s not uncommon for a desperately ill patient to be released from the hospital within 24 hours of receiving a fecal transplant.
Studies are ongoing, but for now fecal transplantation is believed by many to be the best treatment available for antibiotic resistant, recurrent C. difficile infections.
– Obesity
We now know that the particular mix of microbes residing in a person’s gut can influence their weight. Given their role microbes play in digestion, it is not surprising that they can also influence how efficient a person is at extracting energy (calories) from food. A person with a more efficient metabolism is more likely to gain weight. In times of famine, this is a desirable trait, but with current easy access to high calorie food this is not such a good thing.
With their ability to produce neurotransmitters and hormones, our gut microbes can also influence how much fat our bodies store. They are even believed to be able to influence feelings of hunger and the types of foods we crave.
Research has revealed that making changes to our diet can affect the mix of microbes in our digestive tract, increasing the number of thinness-promoting gut bugs with a diet high in fiber, fruit and vegetables.
However, fecal transplants may be another way to influence a patient’s mix of microbes and thus their weight.
Doctors have recently discussed a case in which they believe a fecal transplant inadvertently led a normal weight woman to become obese in a short amount of time. The patient had a dangerous case of C. difficile. Her obese, but otherwise healthy daughter provided the feces sample that was used in a fecal transplant. The good news was that the patient’s bacterial infection was cured. The bad news is that she quickly became obese, which her doctors attribute to the changed make up of her microbiome subsequent to the treatment. Doctors who are going to perform fecal transplants are now advised to ensure that the donors are not obese, for fear of introducing an intestinal biome composition that promotes obesity.
In animal experiments, it has been shown that inserting the microbes from obese humans into mice raised to be sterile (meaning they have no intestinal microbes) causes the mice to become obese. When bacteria from thin humans was inserted into obese mice, they lost weight.
As a society, we are interested in promoting health, so research is ongoing on how effective fecal transplants from thin donors could be for the treatment of obesity. Certainly fecal transplants are less expensive and less invasive than stomach stapling or Bariatric surgeries as a method of weight control. But controlled studies on efficacy and safety need to be done before this potential treatment can be considered.
A fecal transplant will never be a magic bullet for obesity. Maintaining a healthy weight requires a balanced diet and exercise. However, it could provide some hope for those people who seem to eat the same amount as their thinner peers, but nonetheless do not lose weight.
– Other Conditions
There are other diseases that are closely linked to disturbances in the gut microbiome:
- Ulcerative Colitis
- Inflammatory Bowel Disease
- Irritable Bowel Syndrome
- Diabetes Mellitus
- Crohn’s Disease
- Metabolic Syndrome
Medical researchers in these areas are evaluating what relief, if any, fecal transplants could provide for afflicted patients. Studies in patients with Ulcerative Colitis have so far shown fecal transplantation to be effective for many of them. Crohn’s Disease studies thus far have not been quite as promising. Research into the other conditions mentioned are in their preliminary stages.
Are Fecal Transplants Safe?
Although they have been performed in the US since the 1950’s with notably few adverse event being reported from the over 700 published cases of fecal transplant, the US Food and Drug Agency (“FDA”) has recently become concerned about regulating it, wondering how the easily performed procedure could be regulated to ensure safety and hygiene for the patient.
The FDA, in 2013, shocked researchers by announcing that it had begun regulating human feces as an unapproved drug and that all FMT procedures and clinical trials would require Investigational New Drug (IND) approval. Following an uproar from the medical community and patients who credit their lives to the treatment, it quickly backtracked saying it would only selectively enforce this rule so long as the patient gave the practitioner informed consent to the as-now experimental treatment.
Their concern is not without basis. Historically, not all practitioners have screened donors and samples for communicable diseases. There is little to no long-term data evaluating the safety of changes to the microbiome brought about by fecal transplantation. However, some practitioners, such as the Mayo Clinic in Arizona, perform extensive evaluations on fecal samples to ensure they are not contaminated by disease.
Some patients, attempting to evade the cost and complication of a medically performed fecal transplant have sought out do-it-yourself instructions on the Internet and tried to treat themselves. This is potentially very dangerous and should not be undertaken.
A European medical body, the National Institute for Health and Care Excellence, on the other hand, has taken a different view of the cost benefit analysis of the fecal transplant. It has endorsed the fecal transplant as the preferred treatment for C. difficile.
One can expect standards and regulations of this procedure to rapidly evolve as more research is done and more and more patients demand the treatment.
Who Can be a Donor?
Thus far, the majority of the donors have been family members of the patient. It marginally reduces the “ick factor” of the procedure. People feel more comfortable with feces received from someone with whom they are already in intimate contact and perhaps sharing bodily fluids. Also, as the microbiomes of related or co-habitating individuals are often similar, the microbes in the donated stool sample would more closely resemble the patient’s pre-disease microbiome.
Preferably, they are pre-screened to ensure that they do not have any communicable or blood-borne illnesses that could be inadvertently passed along to the patient.
It is not far-fetched to think that there will be a time when like sperm or egg donors, there will be stool donors with desirable traits. In fact, a fecal donor registry has emerged to try to create transparency to the process of identifying donors.
Conclusion
I find it amazing that after all I was raised to believe, that poop and the bacteria within our poop can have such amazing health benefits for those who are suffering. It’s a wonder that such discoveries have not surfaced more quickly in the medical and health world. However, cynics suggest that because fecal transfers are so “low-tech” and commercially unviable for big medical companies, this procedure has not gotten the scientific attention and medical credibility it might otherwise deserve.
What do you think?
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